Authority: IC 27-10-3-21
Affected: IC 27-10; IC 35
Sec. 14. (a) The certificate of completion for a prelicensing class required by section 11 of this rule is as follows:
| CERTIFICATE OF COMPLETION |
|---|
| PRELICENSING |
| BAIL BOND OR RECOVERY AGENT LICENSE |
| This Certificate must be presented at the examination site and must be accompanied by two (2) forms of identification, one of which must include a photograph. This Certificate is valid for six (6) months after the date issued. |
| ___________________________ | | _______________________________ |
|---|
| Name of Student | | Date of Birth |
| ___________________________ | | _______________________________ |
| Name of School | | Address of School |
| ___________________________ | | _______________________________ |
| Name of Instructor | | City/State Zip Code |
| Days of Week Class Offered (circle): | M | T | W | TH | F | S | S |
|---|
| Date and Time of Class: ________________________________________________ |
| Total number of hours of class instruction received by applicant at the above location and time and in the presence of the above instructor(s) ______________ |
| I hereby certify, under penalty of perjury, that the above information is true and correct to the best of my knowledge and belief and I understand that a false statement is cause for denial, suspension, or revocation of a class approval. |
| ___________________________ | | ______________________________ |
|---|
| Date | | Instructor's Name (print) |
| | ______________________________ |
| | Instructor's Signature |
| I hereby certify, under penalty of perjury, that the above information is true and correct to the best of my knowledge and belief, and I understand that a false statement is cause for denial, suspension, or revocation of a bail bond license. |
| ______________________ | | ______________________________ |
|---|
| Date | | Applicant's Name |
| | ______________________________ |
| | Applicant's Signature |
(b) The certificate of completion for a continuing education class required by section 11 of this rule is as follows:
| CERTIFICATE OF COMPLETION |
|---|
| CONTINUING EDUCATION |
| BAIL BOND OR RECOVERY AGENT LICENSE |
| This Certificate shall be submitted to the Department of Insurance along with the renewal application. |
| _____________________________ | | ___________________________________________________ |
|---|
| Name of Student | | Date of Birth |
| _____________________________ | | ___________________________________________________ |
| Name of School | | Address of School |
| _____________________________ | | ___________________________________________________ |
| Name of Instructor | | City/State Zip Code |
| Days of Week Class Offered (circle): | M | T | W | TH | F | S | S |
|---|
| Date and Time of Class: ____________________________________________ |
| Total number of hours of class instruction received by applicant at the above location and time and in the presence of the above instructor(s): __________ |
| I hereby certify, under penalty of perjury, that the above information is true and correct to the best of my knowledge and belief, and I understand that a false statement is cause for denial, suspension, or revocation of a class approval. |
| ___________________________ | | ______________________________ |
|---|
| Date | | Instructor's Name (print) |
| | ______________________________ |
| | Instructor's Signature |
| I hereby certify, under penalty of perjury, that the above information is true and correct to the best of my knowledge and belief, and I understand that a false statement is cause for denial, suspension, or revocation of a bail bond license. |
| _____________________________ | | ______________________________ |
|---|
| Date | | Agent's Name (print) |
| | ______________________________ |
| | Agent's Signature |
(Department of Insurance; 760 IAC 1-6.2-14; filed Jun 30, 2006, 3:30 p.m.: 20060726-IR-760050133FRA; readopted filed Nov 21, 2012, 4:15 p.m.: 20121219-IR-760120454RFA; readopted filed Nov 13, 2018, 10:02 a.m.: 20181212-IR-760180372RFA; readopted filed Oct 31, 2024, 3:52 p.m.: 20241127-IR-760230814RFA)