License Cancellation Request - LIC CC2

California Department of Insurance
 

California 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. 8/2024) 

The licensee's National Producer Number (NPN) can be retrieved using the following link: NPN Lookup

Who is completing this form?

Please cancel the following license type(s):

Licensee or Officer Certification

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 California 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.