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California Department of Insurance
License Cancellation Request California Insurance Code Section 1708
300 Capitol Mall 16th floor Sacramento, CA 95814-4309 (800) 967-9331 www.insurance.ca.gov
LIC CC2 (Rev. 9/2022)
The licensee's National Producer Number (NPN) can be retrieved using the following link: NPN Lookup
Please cancel the following license type(s):
I certify (or declare) under penalty of perjury, under the laws of the State of California, that I am the licensee and that I understand that I am no longer authorized to transact insurance under the license stated above. Pursuant to Insurance Code Section 1708, I authorize the surrender for cancellation the license stated above which permitted me to act in the capacity of the authority of this license. This form is my written notice to the Commissioner of the cancellation of said license.
Please allow 12 to 14 business days for processing this request.
License Number/Application ID Number and Email must match what is on file at CDI. Please click Back and correct on first tab.