Fillable Form AL-F (01/2013): Request to Voluntarily Cancel or (Alabama Department of Insurance)

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Form AL-F (01/2013): Request to Voluntarily Cancel or (Alabama Department of Insurance)

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The Form AL-F (01/2013): Request to Voluntarily Cancel or (Alabama Department of Insurance) form is 1 page long and contains:

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  • 7 check-boxes
  • 4 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Alabama Department of Insurance

BROWSE ALABAMA DEPARTMENT OF INSURANCE (AL) FORMS

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Form AL-F (01/2013)
STATE OF ALABAMA – DEPARTMENT OF INSURANCE
Request to Voluntarily
Cancel or Surrender License
Please use this form to voluntarily cancel or surrender your license. Please note this form only
cancels your license, effective the date we receive notice. It does not clear your license for a
Clearance Letter. Producers and Service Representatives have 12 months from the date in which
the license was canceled to have this license reissued. Producers and Service Representatives
should contact the Alabama Department of Insurance prior to that time to have a license reissued.
PLEASE CLEARLY PRINT OR TYPE ALL INFORMATION IS REQUIRED
Licensee’s Full Name:
National Producer #, SSN, or FEIN:
Alabama License #:
PLEASE CHECK WHAT TYPE OF LICENSE YOU WANT TO CANCEL BELOW:
Producer Title Insurance Agent
Service Representative Adjuster
Business Entity Producer Surplus Line Broker
Temporary
I hereby request the cancellation of my license effective immediately. I understand this
license may be reissued within 12 months without having to re-take the prelicensing
course or the examination, but I would have to address any outstanding issues, such as
continuing education or address change violations, before the license can be reissued.
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Form AL-F (012013): Request to Voluntarily Cancel or (Alabama Department of Insurance)

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Completed 13 October 2021

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