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

Form MLW-01 is a Kentucky Department of Insurance form also known as the "Request For Waiver Of Renewal Procedures Or Exemption From Examination Or Extension For Continuing Education Due To Active Military Service Deployment". The latest edition of the form was released in March 1, 2010 and is available for digital filing.

Download an up-to-date Form MLW-01 in PDF-format down below or look it up on the Kentucky Department of Insurance Forms website.

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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)

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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