Form MLW-01 "Request for Waiver of Renewal Procedures or Exemption From Examination or Extension for Continuing Education Due to Active Military Service Deployment" - Kentucky

What Is Form MLW-01?

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

Form Details:

  • Released on March 1, 2010;
  • The latest edition provided by the Kentucky Department of Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form MLW-01 by clicking the link below or browse more documents and templates provided by the Kentucky Department of Insurance.

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Download Form MLW-01 "Request for Waiver of Renewal Procedures or Exemption From Examination or Extension for Continuing Education Due to Active Military Service Deployment" - Kentucky

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Form MLW-01 (3-2010)
KENTUCKY DEPARTMENT OF INSURANCE
AGENT LICENSING DIVISION
P.O. Box 517
Frankfort, KY 40602-0517
502-564-6004
http://insurance.ky.gov/
REQUEST FOR
WAIVER OF RENEWAL PROCEDURES
or
EXEMPTION FROM EXAMINATION
or
EXTENSION FOR CONTINUING EDUCATION
DUE TO ACTIVE MILITARY SERVICE DEPLOYMENT
_________________________________________
_____________________
(_____)___________
(Licensee Name)
(DOI #)
(Telephone Number)
__________________________________________
_________________________________________
(Street or Post Office Address)
(City, State, and ZIP)
PLEASE CHECK APPROPRIATE REQUEST:
____ Waiver of Renewal Penalties and Sanctions*. Attachments required:
Explanation of which renewal procedures should be waived and why.
Documentation proving or affidavit swearing to the dates of active military service and deployment.
____ Waiver of Continuing Education Requirements*. Attachments required:
Explanation of why continuing education requirements could not be completed within the 2-year
biennium period.
Demonstrate that you have given a good faith effort to meet requirements prior to deployment.
Documentation proving or affidavit swearing to the dates of active military service and deployment.
____ Exemption of Examination*. Attachments required:
Explanation of which renewal procedures should be waived and why.
Documentation proving or affidavit swearing to the dates of active military service and deployment.
____ Extension of continuing Education Requirement**. Attachments required:
Explanation of why continuing education requirements could not be completed within the 2-year
biennium period.
Extension date _______________ requested to complete the required continuing education hours
(maximum 2 years). Include an explanation of why this specific period is needed.
Demonstrate that you have given a good faith effort to meet requirements prior to deployment.
Documentation proving or affidavit swearing to the dates of active military service and deployment.
____________________________________________________
______________________
(Signature)
(Date)
NOTE: The Department will review requests on a case by case basis and will provide a response in
writing.
* KRS 304.9-200(3)
**KRS 304.9-295(7)
Form MLW-01 (3-2010)
KENTUCKY DEPARTMENT OF INSURANCE
AGENT LICENSING DIVISION
P.O. Box 517
Frankfort, KY 40602-0517
502-564-6004
http://insurance.ky.gov/
REQUEST FOR
WAIVER OF RENEWAL PROCEDURES
or
EXEMPTION FROM EXAMINATION
or
EXTENSION FOR CONTINUING EDUCATION
DUE TO ACTIVE MILITARY SERVICE DEPLOYMENT
_________________________________________
_____________________
(_____)___________
(Licensee Name)
(DOI #)
(Telephone Number)
__________________________________________
_________________________________________
(Street or Post Office Address)
(City, State, and ZIP)
PLEASE CHECK APPROPRIATE REQUEST:
____ Waiver of Renewal Penalties and Sanctions*. Attachments required:
Explanation of which renewal procedures should be waived and why.
Documentation proving or affidavit swearing to the dates of active military service and deployment.
____ Waiver of Continuing Education Requirements*. Attachments required:
Explanation of why continuing education requirements could not be completed within the 2-year
biennium period.
Demonstrate that you have given a good faith effort to meet requirements prior to deployment.
Documentation proving or affidavit swearing to the dates of active military service and deployment.
____ Exemption of Examination*. Attachments required:
Explanation of which renewal procedures should be waived and why.
Documentation proving or affidavit swearing to the dates of active military service and deployment.
____ Extension of continuing Education Requirement**. Attachments required:
Explanation of why continuing education requirements could not be completed within the 2-year
biennium period.
Extension date _______________ requested to complete the required continuing education hours
(maximum 2 years). Include an explanation of why this specific period is needed.
Demonstrate that you have given a good faith effort to meet requirements prior to deployment.
Documentation proving or affidavit swearing to the dates of active military service and deployment.
____________________________________________________
______________________
(Signature)
(Date)
NOTE: The Department will review requests on a case by case basis and will provide a response in
writing.
* KRS 304.9-200(3)
**KRS 304.9-295(7)