Insurance Licensing Compliance Assessment Form
Review licensing practices against requirements applicable to your jurisdiction and record any areas needing follow-up.
Organization and Respondent
Organization or agency name
*
Respondent name
*
Respondent role
*
Jurisdiction(s) covered by this assessment
*
Licensing Compliance Assessment
License type(s) in scope
*
Life
Health
Property
Casualty
Other
Overall licensing status
*
Current
Renewal pending
Lapsed
Not applicable
Unsure
Applicable requirements by jurisdiction
*
Rows
Compliant
Needs attention
Not applicable
Unsure
License active
1
2
3
4
Renewal dates tracked
5
6
7
8
Continuing education completed
9
10
11
12
Required appointments maintained
13
14
15
16
Records kept
17
18
19
20
Notes or evidence references
Findings and Follow-up
Identified gaps or corrective actions needed
Planned next step and target completion date
Submit Assessment
Should be Empty: