Numeric listing of Agent / Adjuster forms
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| TDI form number | Description | Format | Language |
|---|---|---|---|
| FIN194 |
Annuity Transaction Disclosure form |
English | |
| FIN195 |
Consumer Refusal to Provide Information Before Buying an Annuity form |
English | |
| FIN196 |
Consumer Disclosure When Buying an Annuity Not Recommended by an Agent |
English | |
| FIN430 |
License Application for a Life Settlement Provider or Broker Original application for licensure of a life settlement broker or provider, which includes checklists for filing requirements of the initial application |
English | |
| FIN431 |
Application for Renewal, Surrender, or Change of Information for a Life Settlement Provider or Broker Application for renewal of a broker or provider license or to report change of information of an existing life settlement broker or provider |
English | |
| FIN432 |
Life Agent Notification to TDI to act as a Life Settlement Broker Required for applicants who have held a resident Texas life or life and health license for at least one year |
English | |
| FIN434 |
Biographical Affidavit for Life Settlement Providers or Brokers Biographical affidavit. Must be completed by all individuals specified in the instructions of FIN430 and FIN431, as adopted by rule. |
English | |
| FIN501 |
Appointment Cancel for Cause Use this form to submit notification of appointment cancellation for cause. All other appointment transactions must be completed electronically using National Insurance Producer Registry or Sircon. |
English | |
| FIN505 |
Licensing Corporate Insurance Agents Bond (aka Insurance Agency Bond) Method of showing proof of financial responsibility to obtain corporate license |
English | |
| FIN509 |
Public Insurance Adjuster Bond - Licensing Certifies that the persons listed on the form are bound to the Texas Department of Insurance in the sum of $10,000 as specified at 28 Texas Administrative Code Section 19.705. |
English | |
| FIN510 |
Licensing Application for Reinsurance Intermediary License For individuals and entities to apply for a Reinsurance Intermediary License under the provisions of TIC, Chapter 4152. |
English | |
| FIN511 |
Licensing Reinsurance Intermediary Biographical Affidavit To register individuals to be associated to a Reinsurance Intermediary License. |
English | |
| FIN512 |
Licensing Reinsurance Intermediary Agent For Service of Process Nonresident Reinsurance Intermediary License applicant or licensee must use this form to appoint a Texas resident on whom a notice or order or process may be served. |
English | |
| FIN513 |
Licensing Reinsurance Intermediary Bond Method of showing proof of financial responsibility for a Reinsurance intermediary License. |
English | |
| FIN514 |
Specialty Insurance License Application Specialty Insurance License Application (Li004, LHL207) |
English | |
| FIN517 |
CE Exemption or Extension Application for licensee CE Exemption or Extension. Revised 07/2020 |
English | |
| FIN520 |
CE provider information update |
English | |
| FIN521 |
Provider Audit Affidavit Used only by continuing education providers. Revised 01/2019 |
English | |
| FIN522 |
Licensee Request for Qualifying Credit TEXAS Qualifying Continuing Education Credit (fka LHL615). Revised 07/2020 |
English | |
| FIN523 |
Request for Association Credit Accepted by TDI Request for Association Credit (fka LHL617). Revised 01/2019 |
English | |
| FIN524 |
Discount Health Care Program Operator Marketers Form Use this form to provide a list of the marketers authorized to sell or distribute the program operator's program under the program operator's name, and a list of the marketing entities authorized to private label the program operator's programs. |
EXCEL | English |
| FIN525 |
Discount Health Care Program Operator Surety Bond Form Use this form of an original surety bond in the principal amount of $50,000 to show Financial Responsibility. Rev. 01/2019 |
English | |
| FIN526 |
Discount Health Care Program Operator Biographical Certificate Form Discount Health Care Program Operator Biographical Certificates. Follow the instructions within the form for completion. Rev 01/2019 |
English | |
| FIN527 |
Discount Health Care Program Operator Registration Form Form for Registration as a Discount Health Care Program Operator. Rev. 01/2019 |
English | |
| FIN528 |
Entity Name Change/ Assumed Name (DBA) Request Use this form to update an official entity name change or register an assumed name (DBA) with TDI. |
English | |
| FIN529 |
Life Agent License Use Affidavit Request CE waiver for life insurance not exceeding $25,000 agent licenses. |
English | |
| FIN530 |
Voluntary Surrender of Texas Insurance License |
English | |
| FIN531 |
Biographical Form and Certification of License Qualification Following a Change of Control Use this form to report changes to control of a licensed insurance agency; or to report new individuals to be associated with or disassociated from a currently licensed insurance agency. |
English | |
| FIN533 |
Agent / Adjuster name or address change request form |
English | |
| FIN535 |
Public Insurance Adjuster Contract This contract form is prescribed by the Texas Department of Insurance to satisfy contract requirements for Public Insurance Adjusters effective January 01, 2014. |
English | |
| FIN540 |
Agency address change request form |
English | |
| FIN548 |
Captive Management Company Biographical Certificate Form Form used for Captive Management Company's Biographical Certificate information. Follow the instructions within the form. |
English | |
| FIN549 |
Captive Management Company Registration Form Form used for Captive Management Company Registration information. Follow the instructions within the form. |
English | |
| FIN594 |
Application for Residency Change to Texas Form for individuals changing state of residency to TX. Agencies must apply for a resident license via Sircon or the National Insurance Producer Registry. |
English | |
| FIN700 |
Appointment certification |
English | |
| FIN705 |
Public Insurance Adjuster (PIA) Checklist |
English | |
| FIN-NA |
CE Example Course Evaluation Sample Only |
English | |
| FINT01 |
Escrow Officer Name/Address Change Request |
English | |
| FINT05 |
CE Exemption/Extension Request |
English | |
| FINT08 |
Title Insurance Licensing Biographical Information |
English | |
| FINT09 |
Escrow Officer Appointment To be completed by authorized appointing official. |
English | |
| FINT10 |
Title Insurance Agent or Direct Operation Appointment To be completed by authorized appointing official. |
English | |
| FINT22 |
Title licensee: continuing education credit request |
English | |
| FINT120 |
Abstract Plant Information Title Agency Abstract Plant Information |
English | |
| FINT122 |
Title Insurance Agent/Direct Operation Bond |
English | |
| FINT123 |
Escrow Officers Schedule Bond |
English | |
| FINT129 |
Title Insurance Agent or Direct Operation Change Request Used for Title Agency information updates |
English |
For more information, contact: License@tdi.texas.gov