Form L-169 - Application For An Individual Insurance License - Arizona Department Of Insurance
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7APPLICATION FOR AN INDIVIDUAL INSURANCE LICENSE (FORM L-169)
INSTRUCTIONS FOR ON-LINE FORM
1. Read all instructions for the application. Incomplete applications will be returned as
deficient, and will delay processing.
2. Using the online form, enter the correct information on the application.
HOW TO ENTER INFORMATION IN THE ONLINE FORM
A. Text fields
(areas on the form where you need to type information)
Figure 1
A
B
C. Full Middle Name
. (Legal) Last Name (including Jr/Sr/etc if applicable)
. Full First Name
Move the mouse so the pointer is positioned over in the box entitled, “A. (Legal) Last Name….” Click the left mouse button
(unless your mouse is set up for left-handed use). The computer will highlight the field, as shown in
This means
Figure 2.
you are able to type information into the Last Name field.
Figure 2
A
B
C. Full Middle Name
. (Legal) Last Name (including Jr/Sr/etc if applicable)
. Full First Name
After entering information into a field, press the TAB key to move to the next field. The example in Figure 3 shows what
would happen if you typed “DOE” as the last name and pressed the TAB key (
).
Figure 3
Figure 3
A
B
C. Full Middle Name
. (Legal) Last Name (including Jr/Sr/etc if applicable)
. Full First Name
DOE
If you hold the SHIFT key down while you press the TAB key, you can move to the previous field. The example shown in
shows what would happen if you typed “PAT” as the first name and pressed the SHIFT+TAB key combination to
Figure 4
move back to the Last Name field.
Figure 4
A
B
C. Full Middle Name
. (Legal) Last Name (including Jr/Sr/etc if applicable)
. Full First Name
DOE
PAT
B. Check boxes
(areas on the form where you would normally write an “X” or check mark)
Figure 5
Life Insurance Producer
To have an “X” marked in a check box, use your mouse and click on the box.
Accident and Health or
To remove an “X” from the check box, click on the box again. See
Figure 5.
Sickness Producer
C. Option boxes
(areas on the form where you need to choose one option among two or more options)
Figure 6
B
Have you EVER had any professional, vocational, busness license or certification refused, denied,
suspended, revoked or restricted, or a fine imposed by any public authority?
Yes
No
With option boxes, as shown in Figure 6, one of the options will always be selected. To change the option that is selected,
use your mouse and click on the correct option. Figure 7 shows what would happen if you clicked on the box representing
the option “No.”
Figure 7
B
Have you EVER had any professional, vocational, busness license or certification refused, denied,
suspended, revoked or restricted, or a fine imposed by any public authority?
Yes
No
Need help? Call the Insurance Licensing Section from 8AM-5PM, Mondays through Fridays: 602-912-8470
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