Insurance Licensing Exam Score Verification Form
Submit your details to verify your insurance licensing exam results. Please provide only non-sensitive information for accurate matching.
Full Name
*
First Name
Last Name
Date of Birth (Month and Year only)
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Last 4 Digits of Personal ID (e.g., SSN, License, or Student ID)
*
Exam Type
*
Please Select
Life Insurance
Health Insurance
Property & Casualty
Adjuster
Other
Exam Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Exam Center or Institution Name
*
Exam Score (as reported)
*
How would you rate your exam experience?
1
2
3
4
5
Submit Verification
Should be Empty: