Cal. Code Regs. tit. 10 § 2548.25

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Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 2548.25 - Business Entity Endorsement Form

State of California

Department of Insurance

Business Entity Endorsement

LIC 411-8A (Rev 04/2014)

___________________________

Producer Licensing Bureau

P.O. Box 1139

Sacramento, CA 95812-1139

(916) 322-3555 or (800) 967-9331

www.insurance.ca.gov

Pursuant to Section 1627 and 1661 of the Insurance Code

License Number of Business Entity: ____________________

Business Entity Name:

Mailing Address:

City, State, Zip:

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 LI - Life-Limited to the Payment of Funeral & Burial Expenses

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****	Endorsee's Name (as shown on license)	Effective Date of Endorsement
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Signature and title of authorized representative.

-	Title:	Date:
E-mail:		Phone Number: ()

Filing fee: Submit $26 filing fee per endorsement type. Enter number of endorsements: __________ X $26 __________

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:	California Department of Insurance
	Mail Endorsement form and fee to -	P.O. Box 957
	or	Sacramento, CA 95812-0957

2.	If endorsement is being submitted with original application	California Department of Insurance
	Mail Endorsement form with application and fee to -	P.O. Box 1139
		Sacramento, CA 95812-1139

* If endorsing both Accident and Health Agent and Life-Only Agent submit only one filing fee.

** For Credit Insurance applicants only: submit $34 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, § 1798.17; 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 (800-967-9331) or by mail, to the following address: 320 Capitol Mall, Sacramento CA 95814.

Cal. Code Regs. Tit. 10, § 2548.25

1. New section filed 7-29-2010 as an emergency; operative 7-29-2010. Emergency regulation shall remain in effect, not to be repealed by the Office of Administrative Law, unless repealed by the Department of Insurance pursuant to Insurance Code section 10113.35 (Register 2010, No. 31).
2. Change without regulatory effect amending NOTE filed 1-24-2012 pursuant to section 100, title 1, California Code of Regulations (Register 2012, No. 4).
3. Change without regulatory effect amending form and NOTE filed 7-3-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 27).
4. Change without regulatory effect amending form filed 8-14-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).
5. Renumbering of former section 2548.25 to section 2548.26 and renumbering of former section 2548.24 to new section 2548.25 filed 11-25-2014; operative 1-1-2015 (Register 2014, No. 48).

Note: Authority cited: Sections 10113.35 and 12978, Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); 20th Century Ins. Co. v. Garamendi, 8 Cal.4th 216 (1994). Reference: Sections 10113.1 and 10113.2, Insurance Code.

1. New section filed 7-29-2010 as an emergency; operative 7-29-2010. Emergency regulation shall remain in effect, not to be repealed by the Office of Administrative Law, unless repealed by the Department of Insurance pursuant to Insurance Code section 10113.35 (Register 2010, No. 31).
2. Change without regulatory effect amending Note filed 1-24-2012 pursuant to section 100, title 1, California Code of Regulations (Register 2012, No. 4).
3. Change without regulatory effect amending form and Note filed 7-3-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 27).
4. Change without regulatory effect amending form filed 8-14-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).
5. Renumbering of former section 2548.25 to section 2548.26 and renumbering of former section 2548.24 to new section 2548.25 filed 11-25-2014; operative 1/1/2015 (Register 2014, No. 48).