Form DFS-H2-1109 "Reduction of Continuing Education Requirement" - Florida

Form DFS-H2-1109 is a Florida Department of Financial Services form also known as the "Reduction Of Continuing Education Requirement". The latest edition of the form was released in October 1, 2014 and is available for digital filing.

Download an up-to-date Form DFS-H2-1109 in PDF-format down below or look it up on the Florida Department of Financial Services Forms website.

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Download Form DFS-H2-1109 "Reduction of Continuing Education Requirement" - Florida

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DEPARTMENT OF FINANCIAL SERVICES
Division of Agent & Agency Services – Bureau of Licensing
200 East Gaines Street, Larson
Building, Tallahassee, FL 32399-0319
Reduction of Continuing Education Requirement
To qualify for a reduction in your continuing education requirement you must complete this form and return it to
the address above with the required documentation. A certifying individual other than the applicant must
complete the statement of experience. Documentation of designation or degree must be attached as well as
proof of experience as a licensed agent or adjuster if experience was obtained outside of Florida.
Applicant Name:
Applicant License #:
To be eligible for continuing education reduction, the applicant must have:
1. A CLU or CPCU designation with 25 years of experience as a licensed agent or adjuster in the same
line of business as the designation, i.e., 25 years experience as a life and health agent and CLU
designation or;
2. A college degree in Risk Management or insurance with at least 18 semester hours of approved
insurance courses and 25 years of experience as a licensed agent or adjuster in the same line of
business as the license.
This form must be submitted with all written documentation prior to the applicant’s birth month in the
year in which compliance for continuing education is due to be considered for the credit.
________________________________________
___________________________________
Signature of Applicant
Date Signed
Statement of Experience
This must be completed by a certifying individual other than the applicant.
I certify that the applicant above is known to me and that I have known him/her to be a licensed agent or
adjuster in the State of
_______________, for _____________ years.
___________________________________
___________________________________
Type or Print Name
Signature
___________________________________
___________________________________
Business Name
Date Signed
___________________________________
Telephone Number
NOTE: If you lose your CLU or CPCU designation, you are required to notify the Department. Loss of
designation or authority will invalidate the reduction in CE requirement.
DFS-H2-1109
Rule 69B-228.180, F.A.C.
Revised 10/2014
DEPARTMENT OF FINANCIAL SERVICES
Division of Agent & Agency Services – Bureau of Licensing
200 East Gaines Street, Larson
Building, Tallahassee, FL 32399-0319
Reduction of Continuing Education Requirement
To qualify for a reduction in your continuing education requirement you must complete this form and return it to
the address above with the required documentation. A certifying individual other than the applicant must
complete the statement of experience. Documentation of designation or degree must be attached as well as
proof of experience as a licensed agent or adjuster if experience was obtained outside of Florida.
Applicant Name:
Applicant License #:
To be eligible for continuing education reduction, the applicant must have:
1. A CLU or CPCU designation with 25 years of experience as a licensed agent or adjuster in the same
line of business as the designation, i.e., 25 years experience as a life and health agent and CLU
designation or;
2. A college degree in Risk Management or insurance with at least 18 semester hours of approved
insurance courses and 25 years of experience as a licensed agent or adjuster in the same line of
business as the license.
This form must be submitted with all written documentation prior to the applicant’s birth month in the
year in which compliance for continuing education is due to be considered for the credit.
________________________________________
___________________________________
Signature of Applicant
Date Signed
Statement of Experience
This must be completed by a certifying individual other than the applicant.
I certify that the applicant above is known to me and that I have known him/her to be a licensed agent or
adjuster in the State of
_______________, for _____________ years.
___________________________________
___________________________________
Type or Print Name
Signature
___________________________________
___________________________________
Business Name
Date Signed
___________________________________
Telephone Number
NOTE: If you lose your CLU or CPCU designation, you are required to notify the Department. Loss of
designation or authority will invalidate the reduction in CE requirement.
DFS-H2-1109
Rule 69B-228.180, F.A.C.
Revised 10/2014
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