760 Ind. Admin. Code 1-50-13.5
Authority: IC 27-1-15.7-7
Affected: IC 27-1-15.6-3; IC 27-1-15.7-2
Sec. 13.5.
The form referenced in section 13 of this rule is as follows:
CONTINUING EDUCATION EXEMPTION FORM
FOR RETIRED INSURANCE PRODUCERS
AND SOLICITORS
I, _____________________, do hereby attest that effective __________ I am retired and am no longer an active insurance producer. I will not solicit or service any insurance policy or policyholder. I respectfully request that I be exempt from fulfilling the continuing education requirements as prescribed by IC 27-1-15.7-2.
If my current situation changes and I plan to solicit or service insurance policies or policyholders, I will immediately notify the Indiana Department of Insurance of my change in status. I understand that the Department will rescind any continuing education exemption, and I will thereafter be responsible for all continuing education requirements as prescribed in IC 27-1-15.7-2.
I further understand that if I fail to notify the Department of Insurance of any change in my retirement status and I engage in the business of insurance, including soliciting or servicing an insurance policy, I will be subject to administrative sanctions.
___________ _________________
Date Signature
___________ _________________
License number Address
___________ _________________
License expiration date City/State Zip
Subscribed and sworn to before me this _________ day of ___________, ____
___________________
Notary Public
My commission expires: _______________
County of residence: __________________
760 IAC 1-50-13.5