Louisiana Department of Insurance Request for Waiver of ... - ldi la 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the 'Applicant Name' field. This is essential for identifying your application.
3. In 'Part 1 - Employment Experience', list your employers, including their names, cities, and supervisors. Provide a brief description of your job duties for each position.
4. Fill in the employment dates (From and To) for each employer. Ensure these dates reflect your three years of verifiable experience.
5. In 'Part 2 - License History', identify all states where you currently hold or have held an adjuster license.
6. For 'Part 3 – Education and Designations', list any relevant industry designations and training received related to Workers’ Compensation.
7. Finally, certify the information by signing and dating the form at the bottom. Include your Social Security Number as required.

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