2017 Wisconsin Act 278, beginning August 1, 2018, prior to submitting an application for a credential, an individual may apply to the Department for a determination of whether the individual would be disqualified from obtaining the credential due to his or her conviction record. To apply for a predetermination, please fill out
Form 3085 and submit all required documentation specified on the form. Pursuant to
Wis. Stat. §
111.335(4)(e), the offenses or kinds of offenses that may result in a refusal, bar, or termination of licensure are published under Additional Resources on the left side of this page.
2017 Wisconsin Act 319, beginning August 1, 2018, an applicant for an initial credential may apply for a reduction of the initial credential fee that is equal to 10% of the initial fee. Qualification is based on the federal adjusted gross income being at or below 180% of the federal poverty guideline prescribed for the applicant's family household size by the United States Department of Health and Human Services. To determine eligibility please visit the
United States Department of Health and Human Services website prior to submitting
This application must be completed by a licensed Funeral Director or an operator of a Funeral Establishment in order for the applicant to be a registered Agent to sell or solicit the sale of burial agreements funded with the proceeds of a life insurance policy. If the Agent is already registered and wishes to sell or solicit on behalf of a different or additional Funeral Director or operator of a Funeral Establishment, complete Form 2345.
Pre-Credential Education Information
Successful completion of at least 20 hours of approved educational training. An agent who is a WI licensed Funeral Director and a WI licensed insurance intermediary is exempt from completing the 20 hours of approved educational training as provided in Wis. Admin. Code § FD 6.05.
Application for Licensure
2343||Application for Registration as an Agent for Burial Agreements|
|3217||Application for Fee Reduction (This form
must accompany the application for the credential)|
3085||Application for Predetermination
(Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal, state, or local law, including municipal ordinances, in this state or any other)|
2252||Convictions and Pending Charges|
3071||Fax Payment Form|
2344||Notice of Conversion of a Burial Trust to a Burial Agreements|
2345||Notice Concerning Contract Between a Funeral Establishment and an Agent for Burial Agreements|