Form LIC DE 1 Admitted Company Data Extract Order Form - California

Form LIC DE1 or the "Admitted Company Data Extract Order Form" is a form issued by the California Department of Insurance.

The form was last revised in February 1, 2016 and is available for digital filing. Download an up-to-date Form LIC DE1 in PDF-format down below or look it up on the California Department of Insurance Forms website.

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State of California
Department of Insurance
State of California Department of Insurance Admitted Company
Data Extract Order Form
LIC DE 1 (Rev 2/2016)
Producer Licensing Bureau
320 Capitol Mall
Sacramento CA 95814-4344
(800) 967-9331
Customer Name:
Order date:
Customer Company:
Customer E-mail Address:
Telephone number (
)
Mailing Address:
Selection: Please check only one sort order per company type.
Company Type
Sort Order –
Sort Order –
Price
Alphabetical*
Zip**
All Admitted Companies
$ 66.00
Automobile Companies Only
$ 66.00
Workers’ Compensation Companies Only
$ 66.00
Life Companies Only
$ 66.00
Property & Casualty Companies Only
$ 66.00
Total order amount
$
Sales Tax ***
$
$
Total due to California Department of Insurance
Alpha will sort the data by company name
*
**
ZIP will sort the data by zip codes
*** California residents must add your cities 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 additional information, 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
State of California Department of Insurance Admitted Company
Data Extract Order Form
LIC DE 1 (Rev 2/2016)
Producer Licensing Bureau
320 Capitol Mall
Sacramento CA 95814-4344
(800) 967-9331
Customer Name:
Order date:
Customer Company:
Customer E-mail Address:
Telephone number (
)
Mailing Address:
Selection: Please check only one sort order per company type.
Company Type
Sort Order –
Sort Order –
Price
Alphabetical*
Zip**
All Admitted Companies
$ 66.00
Automobile Companies Only
$ 66.00
Workers’ Compensation Companies Only
$ 66.00
Life Companies Only
$ 66.00
Property & Casualty Companies Only
$ 66.00
Total order amount
$
Sales Tax ***
$
$
Total due to California Department of Insurance
Alpha will sort the data by company name
*
**
ZIP will sort the data by zip codes
*** California residents must add your cities 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 additional information, 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

Download Form LIC DE 1 Admitted Company Data Extract Order Form - California

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