Fillable CONTINUING EDUCATION COURSE REPORT FORM (Department of Technology and Information)

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CONTINUING EDUCATION COURSE REPORT FORM (Department of Technology and Information)

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BROWSE DEPARTMENT OF TECHNOLOGY AND INFORMATION (DE) FORMS

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CONTINUING EDUCATION COURSE REPORT FORM
COURSE PROVIDER INSTRUCTIONS
Each course provider is required to distribution a course report form/transcript to each licensee at the completion of a
course.
Providers are required to report continuing education credits electronically to the Delaware Insurance
Department at the following link: https://sbs-de.naic.org/Lion-Web/jsp/login/ext_provider_login.jsp
LICENSEE INSTRUCTIONS
Licensees are required to maintain a copy of the course report form/transcript for their records.
Delaware License # : ________________________________________
National Producer Number (NPN) : ___________________________
General Credit
Course #
Ethic Credit
Provider #
LTC Credit
Com
p
letion Date
Flood Credit
Course Title
Licensee - Name
Provider - Authorized Signature
Revised 05/10
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CONTINUING EDUCATION COURSE REPORT FORM (Department of Technology and Information)

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Completed 20 July 2020

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