Wisconsin Administrative Code
Office of the Commissioner of Insurance
Chapter Ins 26 - Prelicensing Education
Appendix 5 - Certificate of prelicensing education

I hereby certify that ( name) has completed a prelicensing educational course which complies with the requirements in ch. Ins 26, Wis. Adm. Code, for the insurance line of (life) (accident & health) (property) (casualty) (Personal Lines P&C). The last day of class or completion of the required examination(s) for section B of the identified course(s) was (date) . I have verified the identification of this applicant by using:

*A Wisconsin driver's license

*A Wisconsin identification card

*Other (please describe)

Authorized Representative

Date Name of Program