Agent / Adjuster Forms
This is one of several pages linking to a central repository of forms used by TDI customers. Use the search or Forms by Program/Division links on the Forms Home Page or scan through our form listings.
Application Forms | Continuing Education Forms | Discount Heath Care Program Operator Forms | Information Update Forms
| Description | File Format |
|---|---|
| Electronic Resident Agent Application (This is for an Individual applying for a General Lines, Property and Casualty or Life, Accident,Health and HMO only.) Electronic Resident Application Process Tutorial (Select this link to view the Electronic Resident Application Process Tutorial.) | Web Enabled |
| Electronic Non-resident Application (Individual or Entity: Links to NIPR, at the Texas instruction page for the electronic application. That page is linked to a Use Agreement page. The "Agree" button links to the actual application.) | Web Enabled |
| Licensing Application to Renew License Renew License Online | Web Enabled |
| NIPR Electronic Address Change Request (For in-state address changes, an agent or adjuster can use this tool to simultaneously provide an address change notification to all state insurance departments where the agent or adjuster is licensed. There is no charge for the service.) | Web Enabled |
| TDI Form Number | Description | File Format | Language |
|---|---|---|---|
| FastForm for electronic fingerprint appointment | FastPass Form for electronic fingerprint appointment Rev 1/2013 |
English | |
| FastForm for fingerprint card | Fingerprint Card Scan Authorization Form to submit with fingerprint card Rev 1/2013 |
English | |
| FIN506 | Licensing - Individual Application for Insurance License Used by individuals not required to qualify by examination. Previously, form number LI011. Rev 3/2012 |
English | |
| FIN507 | Licensing Application for Insurance Agency License Used by corporations, partnerships, depository institions and other business entity eligible for an insurance agency license under the provisions of the Texas Insurance Code. Rev 3/2012 |
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. Rev 3/2012 |
English | |
| FIN511 | Licensing Reinsurance Intermediary Biographical Affidavit To register individuals to be associated to a Reinsurance Intermediary License. Rev 3/2012 |
English | |
| LHL202 | Licensing Corporate Insurance Agents Bond (AKA Insurance Agency Bond) Method of showing proof of financial responsibility to obtain corporate license. |
English | |
| LHL250 | Annual Nonresident Public Insurance Adjuster Affidavit Fill-in On Screen and Print |
English | |
| LHL256 | Licensing Public Insurance Adjuster Bond 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 §19.705. |
English | |
| LHL627 | Licensing Reinsurance Intermediary Agent For Service or Process Form 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 | |
| LHL628 | Licensing Reinsurance Intermediary Bond Method of showing proof of financial responsibility for a Reinsurance intermediary License. |
English | |
| li004 | Speciality Insurance License Application |
English |
| TDI Form Number | Description | File Format | Language |
|---|---|---|---|
| FIN519 | CE Automatic Fines Transmittal Continuing Education Fines |
English | |
| LHL212 | Application for Provider Registration Application to become an Agent/Adjuster continuing education provider. |
English | |
| LHL213 | Application for Course Certification Application for certification of CE course. |
English | |
| LHL216 | CE Exemption or Extension Application for licensee CE Exemption or Extension. |
English | |
| LHL240 | Course Assignment Form Allows an existing provider to assign the right to give its course to another existing provider. Both must have active provider registrations. |
English | |
| LHL367 | Provider Renewal and Information Change Form Application for Provider Renewal or Change of Contact Information. |
English | |
| LHL386 | Provider Audit Affidavit Used only by continuing education providers |
English | |
| LHL615 | Licensee Request TEXAS Qualifying Continuing Education Credit |
English | |
| LHL617 | Request for Association Credit Accepted by TDI |
English | |
| NA | CE Example Course Evaluation Sample Only |
English |
| TDI Form Number | Description | File Format | Language |
|---|---|---|---|
| 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. An upd |
EXCEL | |
| 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. |
English | |
| FIN526 | Discount Health Care Program Operator Biographical Certificate Form Form for Discount Health Care Program Operator Biographical Certificates. Follow the instructions within the form for completion. |
English | |
| FIN527 | Discount Health Care Program Operator Registration Form Form for Registration as a Discount Health Care Program Operator. |
English |
| TDI Form Number | Description | File Format | Language |
|---|---|---|---|
| FIN530 | Request for Letter(s) of Certification Rev 3/2012 |
English | |
| LHL203 | Registration of Assumed Name/Branch Locations/Entity Name Change Commonly known as form LDTL |
English | |
| LHL208 | ISR Transfer/Cancel Employment Form |
English | |
| LHL238 | Biographical Form Entity/Change of Control |
English | |
| LHL388 | Branch Office Address Change Request |
English | |
| LHL389 | Licensee Name/Address Change Request Form |
English | |
| LHL 430 | Medicare Plan Marketing Report |
EXCEL | |
| NIPR Electronic Address Change Request for Agents and Adjusters - fill in and send on-line. (For in-state address changes, an agent or adjuster can use this tool to simultaneously provide an address change notification to all state insurance departments where the agent or adjuster is licensed. There is no charge for the service.) | Web Enabled | ||
Need software to view files?
Instructions are available for help with downloads.
For more information contact:
