Appendix 5 Certificate Of Prelicensing Education

Latest version.

I hereby certify that ( name ) has completed a prelicensing educational course which complies with the requirements in ch. Ins 26 , Wis. Adm. Code, for the insurance line of (life) (accident & health) (property) (casualty) (Personal Lines P&C) . The last day of class or completion of the required examination(s) for section B of the identified course(s) was (date) . I have verified the identification of this applicant by using:

⍽ A Wisconsin driver's license

⍽ A Wisconsin identification card

⍽ Other (please describe)

Authorized Representative

Date Name of Program

                    
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