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Agent / Adjuster Application Forms

Web Enabled Agent/Adjuster Application 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.)
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
Agent / Adjuster Application Forms
TDI Form Number Description File FormatLanguage
Licensing Corporate Insurance Agents Bond (aka Insurance Agency Bond)
Method of showing proof of financial responsibility to obtain corporate license.
PDF English
Individual Application for Insurance License
Used by individuals not required to pass a qualifying examination via Pearson VUE. Also used to apply for a Provisional Permit; for applicable license types. Rev. 01/2018
PDF English
Licensing Application for Insurance Agency License
Used by corporations, partnerships, depository institutions and other business entity eligible for an insurance agency license under the provisions of the Texas Insurance Code. Rev 11/2017
PDF English
Annual Nonresident Public Insurance Adjuster Affidavit
Nonresident public insurance adjusters are required to certify, knowledge of certain laws. Rev. 12/2015
PDF English
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 §19.705.
PDF English
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 12/2015
PDF English
Licensing Reinsurance Intermediary Biographical Affidavit
To register individuals to be associated to a Reinsurance Intermediary License. Rev 12/2015
PDF English
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.
PDF English
Licensing Reinsurance Intermediary Bond
Method of showing proof of financial responsibility for a Reinsurance intermediary License.
PDF English
Specialty Insurance License Application
FIN514 Specialty Insurance License Application (fka Li004,LHL207) Rev. 12/2015
PDF English
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.
PDF English
Application for Residency Change to Texas
Eff. 9/1/2015; Rev 12/2015
PDF English
Fingerprint Service Code Form
Texas Fingerprint Service Code Form
Used by applicants for fingerprinting process to identify Texas as the recipient of results and as authorization.
PDF English

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