Fillable Name Approval Request (California)

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Name Approval Request (California)

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The Name Approval Request (California) form is 3 pages long and contains:

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  • 35 other fields

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STATE OF CALIFORNIA – DEPARTMENT OF INSURANCE
NAME APPROVAL REQUEST
LIC 447-42A (03/2019)
Name Approval Request
Section 1724.5 of the California Insurance Code
Check the box that applies to this request (one request per form):
Name Reservation for New Business Entity
Individual DBA Request (Sole Proprietor)
DBA Name Change (Sole Proprietor)
Business Entity DBA Request
Changes: please check choice(s): business entity name change
business entity DBA change
merger of business entities
1. If you or the bus
iness entity is currently licensed with this department, please provide the name
and license number.
Name____________________________________________________ License #_______________
2. For a producer license, the word “insurance” must appear in the name followed by agency,
services, marketing, sales, center or solutions. You may only have “one” dba (doing business
as) name approved for your use, unless by right of purchase. All names must meet the Name
Approval Criteria stated on the following link: http://www.insurance.ca.gov/0200-industry/0020-
apply-license/0300-business-license/name-approval-criteria.cfm
For a bail license, the name must have the phrase bail bond or bail bonds.
List the business names you wish considered in order of preference. Five choices may be
submitted.
1st: ________________________________________________________________
2nd: ________________________________________________________________
3rd: ________________________________________________________________
4th: ________________________________________________________________
5th: ________________________________________________________________
Sole proprietor (Individual)
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Name Approval Request, Form LIC 447-42A, (Continued)
3. Type of entity or sole proprietor (please check one):
Corporation
Limited Liability Company
Partnership
Other: (Please list) _____________________________________________________
4. If merger or conversion please submit copy of approved documentation from the Secretary of
State.
5. Additional comments:
________________________________
Zip code
__
__
_________________________________________________________________
_ _ ________________ ____________________
________________________________________________
Name Approval Request, Form LIC 447-42A (Continued)
6. The fee for application or request for approval of true or fictitious name (except there is no fee
when the name is contained in an original application) is as follows:
Producer $58
Bail $32
(Submit copy of your Bail Bond Underwriting Agreement with your surety company).
Adjuster:
Independent
Add or Change $28
Reissue $32
Public
Add or Change $28
Reissue $28
Mail documents and fees to:
Department of Insurance
P.O. Box 1139
Sacramento, CA 95812-1139
Signature: ________________________________________________________________________
(Must be signed by Sole Proprietor or Officer of the Business Entity)
Title: Phone Number: (_ ___ -______
Printed Name: _
Address: _________________________________________________________________________
___________________________________________________________________
___)
City State
E-mail address:
If you have any questions, please call appropriate Unit noted below or email LicDocuments@Insurance.ca.gov.
You may also mail your concerns to the California Department of Insurance, 320 Capitol Mall, Sacramento, CA
95814.
• Business Entity Unit: (916) 492-3069
• Adjuster Unit: (916) 492-3085
• Bail Unit: (916) 492-3035
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Name Approval Request (Continued)
Information for Adjusters can be found in Sections 14042 and 15031 of the California Insurance
Code.
Section 7540 of the Business and Professions Code states in part:
No licensee shall conduct a business under a fictitious or other business name unless and until
he has obtained the written authorization of the bureau to do so.
The bureau shall not authorize the use of a fictitious or other business name, which is so
similar to that of a public officer or agency or of that used by another licensee that the public
may be confused or misled thereby.
The authorization shall require, as a condition precedent to the use of any fictitious name, that
the licensee comply with Chapter 5 (commencing with Section 17900) of Part 3 of Division 7 of
the California Code of Regulations.
───────────────────────────────────────────────────────────────
Section 17900 of the Business and Professions Code states:
a. As used in this chapter, "fictitious business name" means:
(1) In the case of an individual, a name that does not include the surname of the individual or
name that suggests the existence of additional owners.
(2) In the case of a partnership or other association of persons, a name that does not include
the surname of each general partner or a name that suggests the existence of addition
owners.
(3) In the case of a corporation, any name other than the corporate name stated in its articles
of incorporation.
b. A name that suggests the existence of additional owners within the meaning of subdivision (a)
is one which includes such words as "Company," "& Company," "& Son," "& Sons," "&
Associates," "Brothers," and the like, but not words that merely describe the business being
conducted.
───────────────────────────────────────────────────────────────
The use of any true or fictitious name (other than the bona fide natural name of an individual) by a
licensee or applicant for such license is subject to disapproval by the Commissioner (Refer to
California Insurance Code Sections 1724.5, 1759.10, 1811, 1841, 14042, and 15031).
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Name Approval Request (California)

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Completed 21 April 2022

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