Form LIC DE3 "Producer Licensing Bureau Ce Expiration Data Extract Order Form" - California

What Is Form LIC DE3?

This is a legal form that was released by the California Department of Insurance - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2019;
  • The latest edition provided by the California Department of Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form LIC DE3 by clicking the link below or browse more documents and templates provided by the California Department of Insurance.

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Download Form LIC DE3 "Producer Licensing Bureau Ce Expiration Data Extract Order Form" - California

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State of California
Department of Insurance
Producer Licensing Bureau CE Expiration Data Extract
Order Form
LIC DE 3 (Rev 3/2019)
Customer Name:
Order date
Customer Company:
Customer E-Mail Address:
Telephone number (
Mailing Address:
Selections: These selections will furnish all agents that have not yet completed their
continuing education requirements. Please select from the below four line items you
wish to order.
Company Type
Choice
Price
Three Months
$ 330.00
Four Months
$ 550.00
Five Months
$ 770.00
Six Months
$ 990.00
Total order amount
$
Sales Tax *
$
Total due to the California Department of Insurance
$
* California residents must add local sales tax. Here is a link for California sales tax:
https://www.cdtfa.ca.gov/taxes-and-fees/rates.aspx.
Send this completed form with your check to the California Department of Insurance, Attn:
Mailing List Technician, 320 Capitol Mall, Sacramento, CA 95814-4344.
For further listing inquiries please call (916) 492-3063 which is a voice mail box, or e-mail the
Producer Mailing List Technician at
listings@insurance.ca.gov
Complete payment must be enclosed or order will not be processed.
Producer License Bureau (800) 967-9331
State of California
Department of Insurance
Producer Licensing Bureau CE Expiration Data Extract
Order Form
LIC DE 3 (Rev 3/2019)
Customer Name:
Order date
Customer Company:
Customer E-Mail Address:
Telephone number (
Mailing Address:
Selections: These selections will furnish all agents that have not yet completed their
continuing education requirements. Please select from the below four line items you
wish to order.
Company Type
Choice
Price
Three Months
$ 330.00
Four Months
$ 550.00
Five Months
$ 770.00
Six Months
$ 990.00
Total order amount
$
Sales Tax *
$
Total due to the California Department of Insurance
$
* California residents must add local sales tax. Here is a link for California sales tax:
https://www.cdtfa.ca.gov/taxes-and-fees/rates.aspx.
Send this completed form with your check to the California Department of Insurance, Attn:
Mailing List Technician, 320 Capitol Mall, Sacramento, CA 95814-4344.
For further listing inquiries please call (916) 492-3063 which is a voice mail box, or e-mail the
Producer Mailing List Technician at
listings@insurance.ca.gov
Complete payment must be enclosed or order will not be processed.
Producer License Bureau (800) 967-9331