760 IAC 1-50-13.5 Retirement exemption form

Sec. 13.5. The form referenced in section 13 of this rule is as follows: CONTINUING EDUCATION EXEMPTION FORM FOR RETIRED INSURANCE PRODUCERS AND SOLICITORS I, _____________________, do hereby attest that effective __________ I am retired and am no longer an active insurance producer. I will not solicit or service any insurance policy or policyholder. I respectfully request that I be exempt from fulfilling the continuing education requirements as prescribed by IC 27-1-15.7-2. If my current situation changes and I plan to solicit or service insurance policies or policyholders, I will immediately notify the Indiana Department of Insurance of my change in status. I understand that the Department will rescind any continuing education exemption, and I will thereafter be responsible for all continuing education requirements as prescribed in IC 27-1-15.7-2. I further understand that if I fail to notify the Department of Insurance of any change in my retirement status and I engage in the business of insurance, including soliciting or servicing an insurance policy, I will be subject to administrative sanctions. Date Signature License number Address License expiration date City/State Zip Subscribed and sworn to before me this _________ day of ___________, ____ ____________________________________ Notary Public My commission expires: _______________ County of residence: __________________