California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 1 - Production of Insurance
Article 4.5 - Procedures Governing Persons Subject to Title 18 United States Code Section 1033
Section 2175.9 - Standard Form of Application for Requesting Written Consent

(a) Prohibited Persons seeking the Commissioner's Written Consent will use the NAIC Short Form Application For Written Consent to Engage in the Business of Insurance Pursuant to 18 U.S.C. § 1033 and 1034 for the use of Prohibited Persons (dated 1998), which is incorporated herein by this reference. The Prohibited Person seeking Written Consent must sign the Application.

(b) The Commissioner may request additional information at any time from an Applicant to support a pending Application for Written Consent. The Applicant is required to support a pending Application by promptly providing any requested information. Failure to provide such information may result in the Commissioner's denial of the Application.

(c) If consent is denied, the Applicant and the employer identified in the application will be notified in writing of the basis for that denial. The Notice of Denial will provide the Applicant with a denial statement as well as a time line and instruction for any appeal of the denial.

(d) Upon approval, the Commissioner will provide documentation of Written Consent containing the terms and conditions upon which the consent has been granted. Failure to comply with all terms and conditions of consent will result in the immediate termination of consent and summary revocation of license to transact the business of insurance. Terms and conditions of consent may include, but are not limited, to the following:

Any subsequent misdemeanor or felony charge involving dishonesty, breach of trust or violation of 18 U.S.C. § 1033 against a Prohibited Person;

Failure to notify the Department of any misdemeanor or felony charge involving dishonesty, breach of trust or violation of 18 U.S.C. § 1033 against a Prohibited Person;

The filing of an Administrative sanction against a Prohibited Person;

Failure to comply with any provision of these regulations;

Failure to notify the Department upon the filing of any action against a Prohibited Person by a regulator;

Failure to amend an application for Written Consent upon a change in job duties;

Failure to notify employer of status as a Prohibited Person.