Form LIC-441-9, last revised in January 2021, supports two form types: permanent licenses and certificates of convenience. Whether applying for the first time or expanding an existing credential, this form covers a broad range of license categories, including life, health, property, casualty, motor club, personal lines, and surplus line brokerage. Existing licensees can also use it to renew or update their credentials, making it the standard licensing tool throughout a producer's career.
Applicants must complete the form with accurate personal and professional information, including legal name, contact information, residency, citizenship status, and affiliations with financial institutions. The form also needs a thorough five-year work history covering all employment, self-employment, unemployment, and full-time schooling periods. Having the right paperwork ready in advance speeds up the review and submission workflow considerably. A checklist of required supporting materials from the CDI website can help you prepare.
A critical part of the form is the background disclosure section, where applicants must report any convictions, administrative proceedings, or financial delinquencies that could affect license eligibility. If you have questions about specific disclosure standards, consult a CDI service representative. Failing to fully disclose relevant information may result in form denial or future license revocation. Non-resident producers follow the same licensing workflow as resident applicants and are subject to the same standards.
Before submitting, check the current CDI fee schedule, as licensing fees vary by category and state license applications may need additional supporting paperwork. After receiving approval, continuing education requirements apply to every active licensee. Keep a copy of the completed form for your records. For other related license forms, see the NAIC Uniform Application and the Health Coverage Application.
| Question | Answer |
|---|---|
| Form Name | Application Insurance License |
| Form Length | 6 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 30 sec |
| Other names | application naic form, application producer, naic uniform insurance, license application form |
