APPOINTMENT PROCEDURES FOR THE STATE OF CALIFORNIA

Transcription

1 APPOINTMENT PROCEDURES FOR THE STATE OF CALIFORNIA Nation Motor Club, Inc All Representatives/Producers and Firms/Agencies must be licensed and appointed for Motor Club in the State of California. Representatives/Producers who currently hold Fire & Casualty or Motor Club licenses: Submit clear copy of license Individual - Action Notice of Appointment (LIC A) Business Business Entity Endorsement (LIC-411-8A) $44 ($22 fee for individual appointment + $22 fee for business entity appointment) Representatives/Producers who DO NOT currently hold Fire & Casualty or Motor Club licenses will need to do the following: Resident Producers: * Residents can apply for either Fire & Casualty or Motor Club licensure * Online application at through the FLASH system or the resident representatives/producers can submit to Nation Motor Club the Individual Application for Insurance License (441-9) and the Business Entity Application for Insurance License (441-11) o $128 - Individual licensing fee o $128 Business Entity licensing fee For Fire & Casualty license there will be an examination with a $37 fee For Fire & Casualty license the representative/producer must complete the Live Scan Service Request form and submit to the CDI vendor at the examination site, along with a $60.95 fee Individual - Action Notice of Appointment (LIC A) Business Business Entity Endorsement (LIC-411-8A) $44 ($22 fee for individual appointment + $22 fee for business entity appointment) Non-Resident Producers: * Non-residents can only apply for the Fire & Casualty license* Online application at through the Flash system or the nonresident representative/producer can submit to Nation Motor Club the Individual

2 Application for Insurance License (441-9) and the business Entity Application for Insurance License (441-11) o $128 Individual licensing fee o $128 Business Entity licensing fee Submit clear copy of Resident license or certification from domicile state Must submit fingerprint impression card taken by a law enforcement agency Police or Sheriff department standard fingerprint card please enclose a check for $60.95 (fingerprint fees) made payable to L-1 ESD (L-1) Identity Solutions Please note requirement on fingerprint card. You must enter A0042 in the space designated for ORI and you must enter 1000 in the space designated for OCA. REPRESENTATIVES/PRODUCERS FROM THE FOLLOWING STATES ARE NOT REQUIRED TO SUBMIT FINGERPRINTS: Alaska, Arizona, Florida, Georgia, Idaho, Louisiana, Montana, New Jersey, Nevada, Ohio, Oregon, Pennsylvania, Tennessee, Texas, Utah and Washington Individual - Action Notice of Appointment (LIC A) Business Business Entity Endorsement (LIC-411-8A) $44 ($22 fee for individual appointment + $22 fee for business entity appointment) *New Licensing Changes for Resident & Non-Resident Representatives/Producers (Effective 1/1/2011) Please see the attached new licensing changes concerning Fire & Casualty Broker-Agents and Disability Insurance. All licensing, appointment information and fees must be mailed to: NATION SAFE DRIVERS Attn: Compliance Department 800 Yamato Road Suite 100 Boca Raton, Fl Tele: Ext. 516

3 State of California Action Notice of Appointment LIC A (Rev. 7/2010) Department of Insurance Insurer Name: Pursuant to Sections 1704 through 1707 and/or 1673 or 1756 of the Insurance Code FEIN: NAIC # Federal Employer Identification Number To the Insurance Commissioner of the State of California: Notice is hereby given that effective from the date shown on this notice, the designated insurer hereby appoints the person(s) named herein to act as its agent. *When using this form with an Individual Application (LIC 441-9) submit only one name per form and attach the form to the application. **Appoint Type: Only one appointment type per line. ***AH - Accident and Health Agent ***LO - Life-Only Agent LI - Life-Limited to the Payment of Funeral & Burial Expenses FX - Fire/Casualty Broker-Agent AU - Limited Lines Auto Insurance Agent LA - Life and Disability Analyst CS - Cargo Shipper s Agent CI - Credit Insurance Agent PL - Personal Lines Broker Agent MC - Motor Club Agent PF - Part Time Fraternal Agent TA - Travel Agent DO - Disability Only HP - Home Protection Appoint Type ** Social Security/ FEIN License # Name: As shown on license Effective date of Appointment Signature of Insurer: Signature must be that of an officer of the Company or a person authorized under a Special Power of Attorney on file with the Department. Name Official Title Date Phone Number ( ) ***Filing fees: Submit $22 per appointment type. Enter number of appointments X $22 = $ If appointing both Life-Only and Accident and Health, submit only one filing fee. 1. If you are submitting only an action notice Mail Action Notice and fee to: California Department of Insurance OR P.O. Box 928 Sacramento, Ca * If Action Notice is being submitted with original application Mail Action Notice with Application and fee to: California Department of Insurance P.O. Box 1139 Sacramento, Ca

4 State of California Business Entity Endorsement LIC 411-8A (Rev 1/2011) Producer Licensing Bureau P.O. Box 1139 Sacramento, CA (916) or (800) Pursuant to Section 1627 and 1661 of the Insurance Code Department of Insurance Business Entity Name: Mailing Address: License Number To the Insurance Commissioner of the State of California: Effective from the date of filing this notice, the Business Entity hereby endorses the person(s) named to exercise the agency or brokerage powers of the business entity. Note: Enter only one endorsement type per line. (Exception SL/SP) *AH - Accident and Health Agent *LO - Life-Only Agent *VC - Variable Contract Authority LI - Life-Limited to the Payment of Funeral & Burial Expenses *PR - Property Broker Agent *CA - Casualty Broker-Agent FX - Fire/Casualty Broker-Agent AU - Limited Lines Automobile Insurance Agent LA - Life and Disability Analyst CS - Cargo Shipper s Agent **CI - Credit Insurance Agent PL - Personal Lines Broker Agent MC - Motor Club Agent SL - Surplus Line Broker SP - Special Lines Surplus Line Broker SL/SP - Surplus Line & Special Lines Surplus Line Broker *** LS - Life Settlement Broker **Endorsement Type Endorsee s Social Security Number**** Signature and title of authorized representative. Endorsee s Name (as shown on license) Title: Date: Phone Number: ( ) Filing fee: Submit $22 filing fee per endorsement type. Enter number of endorsements: X $22 $ Effective Date of Endorsement Please note, if you are endorsing an applicant for an insurance license, submit only one name per form and attach the form to the application. 1. If you are submitting only an endorsement: Mail Endorsement form and fee to California Department of Insurance, P.O. Box 957, Sacramento, CA or 2. If endorsement is being submitted with original application Mail Endorsement form with application and fee to California Department of Insurance, P.O. Box 1139, Sacramento, CA *If endorsing Accident and Health Agent, Life-Only Agent and Variable Contract Authority or Property Broker Agent and Casualty Broker-Agent submit only one filing fee. ** For Credit Insurance applicants only: submit $31 per endorsement. *** There is no fee for the Life Settlement Broker. **** Disclosure of your U. S. social security number is mandatory pursuant to Cal. Civil Code, ; Cal. Family Code, 17520(d); and Federal Privacy Act of 1974, 7(a) (2) (B) and 7(b). Your social security number will be used primarily for purposes of processing your application, including conducting any necessary investigation into your background. If you fail to disclose your social security number, your application will not be reviewed. An individual has a right of access to certain records containing personal information pertaining to that individual. Individuals may obtain information regarding the location of their records by contacting the Bureau Chief, Producer Licensing Bureau, California Department of Insurance by phone ( ) or by mail, to the following address: 320 Capitol Mall, Sacramento CA

5 Nation Motor Club, Inc. 800 Yamato Road Suite 100, Boca Raton, FL Tele: /Fax REPRESENTATIVE/PRODUCER QUESTIONNAIRE 1. Full name of applicant (First Name) (Middle) (Last) 2. Resident Address (Physical Street) (City) (State, Zip) 3. Home Telephone Number ( ) 4. Social Security Number Date of Birth 6. Property & Casualty License Number (If Applicable) 7. Business Name and Address (Physical Street) (City) (State, Zip) 8. FEIN 9. Business Telephone Number ( ) 10. Business Fax Number ( ) 11. Address I hereby verify my foregoing statements and answers and declare under penalties of perjury that they are correct. This day of, 20 (Applicant s Signature)

6 Nation Motor Club, Inc. 800 Yamato Road Suite 100, Boca Raton, FL Tele: /Fax FIRM/AGENCY QUESTIONNAIRE 1. Business Name and Address (Physical Street) (City) (State, Zip) 2. Business Entity Motor Club License Number 3. FEIN - 4. Date of Incorporation / Formation 5. Business Telephone Number ( ) 5. Business Fax Number ( ) 6. Address 7. Designated Representative/Producer Name 8. Designated Representative/Producer License Number (If Applicable) 9. Identify all owners with 10% interest or voting interest, partners, officers and directors of the business entity, or members or managers of a limited liability company: Owner: Yes / No Name Title SSN/FEIN Owner: Yes / No Name Title SSN/FEIN Owner: Yes / No Name Title SSN/FEIN I hereby verify my foregoing statements and answers and declare under penalties of perjury that they are correct. This day of, 20 (Designated Representative ssignature)

7 STATE OF CALIFORNIA DEPARTMENT OF INSURANCE ADMINISTRATION & LICENSING SERVICES BRANCH PRODUCER LICENSING BUREAU 320 CAPITOL MALL SACRAMENTO, CA (800) OR (916) Steve Poizner, Insurance Commissioner NOTICE TO: All Admitted Insurers, licensed Fire and Casualty Broker-Agents and Other Interested Parties DATE: November 24, 2010 SUBJECT: AB 2782 Important Update Accident and Health Agent License Requirement Background As explained in two recent notices, Assembly Bill (AB) 2782 (Chapter 400, Statutes of 2010) will become effective on January 1, Included among the provisions of the bill is to require all individuals and business entities to hold an accident and health agent license to transact accident and health insurance. Section 1626(a)(2) of the California Insurance Code defines accident and health insurance as insurance coverage for sickness, bodily injury, or accidental death and may include benefits for disability income. Six-Month Extension for Current Fire and Casualty Broker-Agents Since the issuance of the two notices earlier this month, the California Department of Insurance (CDI) received several inquiries from affected licensees and insurers wanting to know who will need the accident and health agent license and also voicing concerns that there isn t enough time prior to January 1, 2011 for all of these individuals to obtain the accident and health agent license. AB 2782 was only signed by the Governor in late September 2010 and based on the responses to our notices, it is evident that many of the affected fire and casualty broker agents are just now finding out about the new requirement. There is only about six weeks left to obtain the accident and health agent license prior to the January 1, 2011 effective date. The number of affected agents and brokers is significantly more than what was originally estimated. Consequently, CDI realizes that it may be a hardship for many of these individuals to obtain the license by this date. As a result, the Commissioner is granting a six-month extension to current fire and casualty broker-agents in which to obtain the accident and health agent license. Fire and casualty broker-agents licensed prior to December 31, 2010 will now have until June 30, 2011 to obtain the accident and health agent license to continue to transact accident and health insurance. The extension applies to both individuals and business entities as well as to both California residents and non-residents. However, individuals as of January 1, 2011 who are not licensed as either an accident and health agent or a fire and casualty-broker agent must obtain the accident and health agent license beginning on January 1, 2011 to be able to transact accident and health insurance. Applying for an Accident and Health Agent license When applying for an accident and health agent license, individual California residents currently licensed as fire and casualty broker-agents will need to complete 20 hours of prelicensing education covering accident and health insurance as well as pass a qualifying examination consisting of 75 questions. As current licensees, the fingerprinting requirement and the 12-hour training requirement on ethics and the California Insurance Code will be waived. Please access Producer Licensing (800)

8 All Admitted Insurers, Licensed Fire and Casualty Broker-Agents, and Other Interested Parties November 24, 2010 Page 2 the following website to obtain detailed information for obtaining an accident and health agent license for both California residents and non-residents and for both individuals and business entities: requirements/accident-health/index.cfm Questions For further information regarding AB 2782, you may access the following link: In addition, CDI is in the process of developing a frequently asked questions webpage specifically to address the accident and health agent license requirement, which will be placed on CDI s Website shortly. For specific questions regarding this notice, please the Producer Licensing Bureau at or call CDI's Producer Licensing Toll Free Hotline at (800) Please be sure to include your name, telephone number, license number and address in all correspondence with the CDI.