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
/code/admin_code/ins/26_5
true
administrativecode
/code/admin_code/ins/26_5
Office of the Commissioner of Insurance (Ins)
administrativecode/ch. Ins 26 Appendix 5
administrativecode/ch. Ins 26 Appendix 5
section
true
