(a) The following forms shall be submitted to the Department at the time of the filing of the initial application for a limited lines travel insurance agent license: (1) A written application for licensure that shall include the following information concerning the applicant: a. Business entity type (e.g., corporation, LLC, general partnership, etc.)b. License type applied for.c. Name of the business entity applicant.d. Federal employer identification number.e. Business address, mailing address, telephone number.f. Fictitious business names the applicant has used or intends to use if approved by the Department.g. Any business activity or activities that the business entity applicant is engaged in, other than insurance, including the nature of any such business activity or activities and the percentage of the business entity applicant's net income derived from the activity or activities.h. Whether the business entity applicant is an insurer.i. Whether the business entity applicant holds or has ever held an insurance license, including the type of license, license number, state issuing the license and dates of licensure.j. Identity of all designated / responsible license producers, including name, social security number, and insurance license number. Disclosure of your U. S. social security number is mandatory pursuant to Insurance Code section 1666.5, Cal. Civil Code, § 1798.17; Cal. Family Code, § 17520(d); and Federal Privacy Act of 1974, §§ 7(a)(2)(B) and 7(b). The 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 (800-967-9331) or by mail, to the following address: 320 Capitol Mall, Sacramento CA 95814-4309.k. Identity of all partners, members officers, directors, managers, controlling persons and any shareholders owning 10% or more interest in the business entity applicant, including name, title, social security number, federal employer identification number, and percentage of ownership.l. Identify of each controlling person as defined in California Insurance Code Section 1668.5(b), including name, title, social security number, federal tax identification number, and percentage of ownership.m. Whether the business entity applicant or any of its partners, members, controlling person, officers, directors, managers, or any shareholder holding 10 percent or interest in the applicant have been convicted or are currently charged with committing a crime. "Crime" includes a felony, a misdemeanor or military offense. "Convicted" includes, but is not limited to, having been found guilty by a verdict of a judge or jury, having entered a plea of nolo contendere, no contest, having had any charge expunged, dismissed or plea withdrawn pursuant to Penal Code Section 1203.4, or having been given probation, a suspended sentence or a fine. Additionally, those applicants disclosing convictions, must provide a written statement with original signature explaining the circumstances of each incident as well as a certified copy of the charging document and a certified copy of the official document which demonstrates the resolution of the charges or any final judgment.n. Whether the business entity applicant or any of its partners, members, controlling persons, officers, directors, managers or any shareholders owning 10% or more interest in the business entity, ever been involved in an administrative proceeding regarding any professional or occupational license. "Involved" means having a license censured, suspended, revoked, canceled, terminated or, being assessed a fine, placed on probation or surrendering a license to resolve an administrative action. "Involved" also means being named as a party to an administrative or arbitration proceeding which is related to a professional or occupational license. "Involved" also means having a license application denied or the act of withdrawing an application to avoid a denial. Additionally, those applicants disclosing involvement in administrative proceedings must provide a signed, written statement explaining the circumstances of each incident leading to such proceeding as well as certified copies of the charging document and of the official document describing the resolution of the proceeding.
o. Whether any demand has been made or judgment rendered against the business entity applicant or any of its partners, members, controlling persons, officers, directors, managers or any shareholders owning 10% or more interest in the business entity for overdue monies by an insurer, insured or producer, and whether the applicant has ever been subject to a bankruptcy proceeding. Additionally, those applicants disclosing such a demand or judgment must submit a statement summarizing the details of the indebtedness and arrangements for repayment.p. Whether the business entity applicant or any of its partners, members, controlling persons, officers, directors, managers or any shareholders owning 10% or more interest in the business entity, have ever been notified by any jurisdiction of any delinquent tax obligation that is not the subject of a repayment agreement. Additionally, those applicants disclosing delinquent tax obligations must identify the jurisdiction in which the tax obligation is delinquent.q. Whether the business entity applicant or any of its partners, members, controlling persons, officers, directors, managers or any shareholders owning 10% or more interest in the business entity, have ever been a party to, or ever been found liable in any lawsuit or arbitration proceeding involving allegations of fraud, misappropriation or conversion of funds, misrepresentation or breach of fiduciary duty. Additionally, those applicants disclosing such lawsuits and or arbitration proceedings must provide a signed, written statement detailing each incident and a copy of both the pleading initiating the lawsuit or arbitration as well as the official document describing the final resolution of such proceeding(s).r. Whether the business entity applicant or any of its partners, members, controlling persons, officers, directors, managers or any shareholders owning 10% or more interest in the business entity, have ever had an insurance agency contract or any other business relationship with an insurance company terminated for any alleged misconduct. Additionally, those applicants disclosing such terminations must provide a signed, written statement describing the each underlying incident and an explanation of why the incident(s) should not result in denial of the license application. The applicant will also be required to provide copies of all relevant documents relating to said termination(s).s. Business entity applicant's certification under penalty of perjury that:i. The named business entity intends actively and in good faith to carry on an insurance business with the general public;ii. The business entity's articles of incorporation or articles of organization or association or partnership agreement, as the case may be, do not forbid it to act in the capacity for which this application is being made;iii. The holding of the license hereby applied for is not incompatible with the laws, rules or regulations of any federal, state, county or municipal government for which it performs work (if any) by which it is licensed (if any);iv. If the license is granted, only those natural persons so authorized will transact insurance under each license;v. The certification must be signed by:1. If the applicant is a partnership, each partner.2. If the applicant is a corporation, an officer having authority to bind the organization.3. If the applicant is a limited liability company, an officer, member or manager having authority to bind the organization.4. If the applicant is a nonprofit corporation or unincorporated association, all members.(2) An insurer's notice of appointment of a limited lines insurance agent applicant made on Form LIC TA 1 (Rev 7/2015). | State of California | Department of Insurance |
| Initial Notice of Appointment--Limited Lines Travel Insurance Agent | |
| LIC TA 1 (Rev 7/2015) | |
Producer Licensing Bureau
P.O. Box 1139
Sacramento, CA 95814-1139
(916) 492-3069
www.insurance.ca.gov
LIMITED LINES TRAVEL INSURANCE AGENT NOTICE OF APPOINTMENT
To California Insurance Commissioner
Pursuant to Sections 1753(a) and 1755(a)(2) of the California Insurance Code
Insurer Name: ___________________________
| FEIN: | __ -_______________________________ | | NAIC # ___________________________ | | CA Company # ___________________________ | |
| Federal Employer Identification Number (FEIN) |
To the Insurance Commissioner of the State of California:
Section 1755 (a)(2) of the California Insurance Code requires that all license applications include a certificate from the insurer that is to be named in the limited lines travel insurance agent license, stating that the insurer has satisfied itself that the named applicant is trustworthy and competent to act as its limited lines travel insurance agent and that the insurer will appoint the applicant to act as its agent if the limited lines travel insurance agent license applied for is issued by the commissioner. The certification shall be subscribed by an officer or managing agent of the insurer.
Notice is hereby given that the designated insurer appoints the travel insurance agent named herein to act as its agent and certifies that it has satisfied itself that the named travel insurance agent is trustworthy and competent to act as its travel insurance agent.
| ___________________________ |
| Limited Lines Travel Agent | FEIN |
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
This is executed on the __________ day of ____________________, 20___.
___________________________
Name of Insurer
Name of Officer or Managing Agent (printed):
___________________________
Signature of Officer or Managing Agent of insurer:
___________________________
Name __________
Official Title (please print): __________
___________________________
Telephone Number () -
(3) An initial certification of authorized travel retailers made on Form | LIC TA 2 (Rev 7/2015). | |
| State of California | Department of Insurance |
| Initial Certification of Authorized Travel Retailers--Limited Lines Travel Insurance Agent | |
| LIC TA 2 (Rev 7/2015). | |
Producer Licensing Bureau
P.O. Box 1139
Sacramento, CA 95814-1139
(916) 492-3069
www.insurance.ca.gov
California Department of Insurance
Initial Certification of Authorized Travel Retailers
Pursuant to Section 1754(a)(2) of the California Insurance Code
| Travel Retailer Name | FEIN or Social Security Number | Name of Manager or Officer | Address and Telephone Number |
| | | |
| | | |
*Under Section 1033 of Title 18 of the United States Code, it is a criminal offense for an individual who has been convicted of a felony involving dishonesty or breach of trust or any violation of 18 U.S.C. § 1033 to willfully engage or participate in the business of insurance unless that person has first obtained the written consent of the appropriate regulatory official. Further, it is a criminal offense for any person to willfully employ, or willfully permit, such "prohibited persons" to participate in the business of insurance without the required written consent. A "Prohibited Person" may be an officer, director or employee of an insurance agency or an insurance company, an agent, solicitor, broker, consultant, third party administrator, managing general agent, or subcontractor representing an insurance agency or insurance company who engages in or transacts the business of insurance.
(4) Training materials containing all of the elements set forth in form | LIC TA 3 (Rev 7/2015). | |
| State of California | Department of Insurance |
| Required Training Elements--Limited Lines Travel Insurance Agent | |
| LIC TA 3 (Rev 7/2015). | |
Producer Licensing Bureau
P.O. Box 1139
Sacramento, CA 95814-1139
(916) 492-3069
www.insurance.ca.gov
California Department of Insurance
Limited Lines Travel Insurance Agent
Outline of Required Training Elements
Pursuant to Sections 1753(c)(1), (2), (3), and Sections 1754(a)(6), (7), and (8)
Section 1754 (a)(6) of the California Insurance Code states that the limited lines travel insurance agent shall use all reasonable means at its disposal to ensure compliance by the travel retailer's employees with their obligations under the law including a requirement that each employee of the agent's travel retailers whose duties include transacting travel insurance must receive training. The training shall be provided whenever there is a material change that requires modification to the training materials, but in no event less frequently than every three years. The training materials, at a minimum, shall contain instruction on the following:
1) Types of insurance offered;2) Ethical sales practices; and,3) Disclosures to prospective insurance customers as referenced in Sections 1754(a)(7)(8) of the California Insurance Code which states the following: a) The limited lines travel insurance agent or the travel retailer provides disclosure to the consumer in either the marketing materials or fulfillment packages that is substantively similar to the following: This plan provides insurance coverage that only applies during the covered trip. You may have coverage from other sources that provides you with similar benefits but may be subject to different restrictions depending upon your other coverages. You may wish to compare the terms of this policy with your existing life, health, home, and automobile insurance policies. If you have any questions about your current coverage, call your insurer or insurance agent or broker.
b) The limited lines travel insurance agent or the travel retailer makes all of the following disclosures to the prospective insured, which shall be acknowledged in writing by the purchaser or displayed by clear and conspicuous signs that are posted at every location where contracts are executed, including, but not limited to, the counter where the purchaser signs the service agreement, or provided in writing to the purchaser: (i) That purchasing travel insurance is not required in order to purchase any other product or service offered by the travel retailer.(ii) If not individually licensed as an insurance agent to transact life-only, accident and health, or property and casualty insurance, that the travel retailer's employee is not qualified or authorized to:(1) Answer technical questions about the benefits, exclusions, and conditions of any of the insurance offered by the travel retailer.(2) Evaluate the adequacy of the prospective insured's existing insurance coverage.4) Section 1753(c) (2) of the California Insurance Code states that travel insurance does not include major medical plans, which provide comprehensive medical protection for travelers with trips lasting six months or longer, including for example, those working overseas as an expatriate or military personnel being deployed. Further, Section 1753(c)(3) of the California Insurance Code states that travel insurance does not include damage waiver contracts, as defined in paragraph (5) of subdivision (a) of Section 1936 of the Civil Code. The phrase "damage waiver" or "collision damage waiver" cannot be used to describe travel insurance coverage, but the insurance contract may otherwise refer to "damage waiver" or "collision damage waiver" provided by a company, as defined in paragraph (1) of subdivision (a) of Section 1936 of the Civil Code.
___________________________
Important:
* Any changes to previously submitted training materials shall be submitted to the California Department of Insurance, with the changes highlighted, at least 30 days prior to their use by the limited lines travel insurance agent. Training materials and changes to those materials submitted to the California Department of Insurance pursuant to this subdivision shall be deemed approved for use by the limited lines travel insurance agent unless it is notified by the department to the contrary.
Failure by a limited lines travel insurance agent to submit training materials or changes for departmental review or use of unapproved or disapproved training materials shall constitute grounds for denial of an application for a license, nonrenewal of a license, or suspension of a license, or other action as deemed appropriate by the commissioner.
(b) An annual certification of authorized travel retailers shall be maintained on Form LIC TA 4 (Rev 7/2015) at the time of licensure and updated annually thereafter. It shall be submitted to the Department upon request. | State of California | Department of Insurance |
| Annual Certification of Authorized Travel Retailers--Limited Lines Travel Insurance Agent | |
| LIC TA 4 (Rev 7/2015). | |
Producer Licensing Bureau
P.O. Box 1139
Sacramento, CA 95814-1139
(916) 492-3069
www.insurance.ca.gov
California Department of Insurance
Annual Certification of Authorized Travel Retailers
Pursuant to Section 1754(a)(2) of the California Insurance Code
| Travel Retailer Name | FEIN or Social Security Number | Name of Manager or Officer | Address and Telephone Number |
| | | |
| | | |
*Under Section 1033 of Title 18 of the United States Code, it is a criminal offense for an individual who has been convicted of a felony involving dishonesty or breach of trust or any violation of 18 U.S.C. § 1033 to willfully engage or participate in the business of insurance unless that person has first obtained the written consent of the appropriate regulatory official. Further, it is a criminal offense for any person to willfully employ, or willfully permit, such "prohibited persons" to participate in the business of insurance without the required written consent. A "Prohibited Person" may be an officer, director or employee of an insurance agency or an insurance company, an agent, solicitor, broker, consultant, third party administrator, managing general agent, or subcontractor representing an insurance agency or insurance company who engages in or transacts the business of insurance.
Note: Authority cited: Section 1757, Insurance Code. Reference: Sections 1754 and 1757, Insurance Code.