Register August 2009 No. 644
APPENDIX 5
CERTIFICATE OF PRELICENSING EDUCATION
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
