Information for Certificate of Completion

Before you request your certificate, you must complete the following:

1. Complete all required study modules in your online course and pass all quizzes

2. Simulate your exam online on the Exam Simulator and score at least 70%

Please submit this electronic form to Insurance Career Training, Inc. by NOON

no later than one business day before your scheduled Indiana insurance exam.

Your certificate will be sent to you by the end of the business day via e-mail.

Complete the information below and click SUBMIT to order your certificate.

The Department of Insurance required we obtain the following information from you to process your certificate:

First Name:

*This question is required.

Middle Name:

Last Name:

*This question is required.

Address Line 1:

*This question is required.

Address Line 2:

City:

*This question is required.

State:

*This question is required.

ZIP Code:

*This question is required.

Date of Birth:

*This question is required. This question requires a valid date format of MM/DD/YYYY.

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10.

Social Security Number:

*This question is required.

11.

Cell Phone #:

*This question is required.

12.

E-Mail Address (where certicificate is to be sent):

13.

For which license are you applying and testing?

*This question is required.

14.

What is your exam date?

This question requires a valid date format of MM/DD/YYYY.

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15.

What is your exam time?

16.

What is your exam location?

17.

Click below if you have not yet scheduled your exam