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 (Optional - If applying for a fee reduction this form
must accompany the application for the credential.)|
3085||Application for Predetermination
Optional-Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal or state law in this state or any other and you desire a review of your conviction record before applying for a credential.) (|
2252||Convictions and Pending Charges (if applicable)|
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|