Company Licensing Forms and Checklists
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| TDI Form Number | Description | File Format | Language |
|---|---|---|---|
| FIN300 | Company Name Application Application to reserve a company name |
English | |
| FIN301 | Life/Health Application for Certificate of Authority Compliance with statutes |
English | |
| FIN302 | HMO Application for Certificate of Authority Compliance with statutes |
English | |
| FIN303 | P&C Application for Certificate of Authority Compliance with statutes |
English | |
| FIN304 | Standard Coverages Page Declares property and casualty lines of business to be listed on Certificate of Authority |
English | |
| FIN305 | Assumed Name Certificate Indicates what the assumed name will be |
English | |
| FIN306 | Officers and Directors Page Complete Listing of all Current Officers and Directors - compliance with statutes |
English | |
| FIN307 | Attorney-in-Fact and Underwriters Page Lists the Attorney-in-Fact and Underwriters of Lloyds and Reciprocals |
English | |
| FIN308 | Budget Projection Form for Life Company Assists in financial review for admission/licensure of a Life Company |
English | |
| FIN309 | Budget Projection Form for P&C Company Assists in financial review for admission/licensure of a P&C Company |
English | |
| FIN311 | Biographical Affidavit Compliance with statutes |
English | |
| FIN313 | Company License Customer Survey Feedback from Applicants |
English | |
| FIN316 | Mortgage Guaranty Affidavit Affidavit that verifies monoline authority |
English | |
| FIN317 | Reinsurer Affidavit Verify applicants understanding of TDI rules |
English | |
| FIN318 | Trust Agreement (U.S. Branch) Agreement between US branch and Texas bank establishing trust |
English | |
| FIN320 | Capital Changes Worksheet Worksheet |
English | |
| FIN321 | Consent Order Waiver Signature page for Commissioner's Order |
English | |
| FIN325 | State of Texas Statement of Retaliatory Fees and Requirements Requirements for insurers, including Capital and Surplus Requirements; Fees; Deposit and Bonds; Premium Tax Requirements; and Additional Taxes |
English | |
| FIN326 | Businesss Plan Outline for Life, Accident & Health Company Filing instruction |
English | |
| FIN327 | Business Plan Outline for P&C Company Filing instruction |
English | |
| FIN328 | Abbreviated Business Plan Filing instruction |
English | |
| FIN329 | Group Hospital Service Corporation Guideline/Checklist |
English | |
| FIN330 | Mexican Casualty Admission Checklist Filing instruction |
English | |
| FIN331 | Domestication of US Branch Filing instruction |
English | |
| FIN332 | Domestic Life & Health Charter Amendment Checklist Checklists for a Texas Life & Health Company Needing to Amend their Articles of Incorporation for Transactions such as Capital Increase/Decrease, Name Change, Home Office Change, and Adding or Deleting a Line of Business |
English | |
| FIN333 | Domestic P&C Charter Amendment Checklists Checklists for a Texas P&C Company Needing to Amend their Articles of Incorporation for Transactions such as Capital Increase/Decrease, Name Change, Home Office Change, and Adding or Deleting a Line of Business |
English | |
| FIN334 | County Mutual Charter Amendment Checklist Filing instruction |
English | |
| FIN335 | Farm Mutual Charter Amendment Checklist Filing instruction |
English | |
| FIN336 | Local Mutual Aid or Burial Association Charter Amendment Guidelines Filing instruction |
English | |
| FIN337 | Increase Authorized or Stated Capital Filing instruction |
English | |
| FIN338 | Adding Variable Annuity Authority Checklist Filing instruction |
English | |
| FIN339 | Adding Variable Life Authority Checklist Filing instruction |
English | |
| FIN340 | Application to Amend Certificate of Authority Filing instruction |
English | |
| FIN341 | Merger involving at least one Domestic Insurer Filing instruction |
English | |
| FIN342 | Conversion of a Domestic Mutual Insurance Company Filing instruction |
English | |
| FIN343 | Foreign Demutualization or Conversion Checklist Filing instruction |
English | |
| FIN345 | Total and Partial Assumption Reinsurance for Domestic Companies Checklist for Total and Partial Assumption Reinsurance Agreements involving at least one Texas domestic insurance company |
English | |
| FIN346 | Checklist for Total and Partial Reinsurance Agreements involving two Foreign Companies Filing instruction |
English | |
| FIN347 | Reinsurance of Mutual Assessment Company into a Stipulated Premium Company Filing instruction |
English | |
| FIN348 | Assumption Certificate Guidelines for Life, Accident, and/or Health Business Filing instruction |
English | |
| FIN349 | Withdrawal checklist Filing instruction for an insurer wanting to withdraw or cease writing a line or lines of insurance |
English | |
| FIN350 | Re-enter Texas Market Subsequent to Withdrawal Guidelines Filing instruction |
English | |
| FIN351 | Voluntary Dissolution Checklist Instructions for a Texas-Domestic Company wanting to Dissolve and Cancel its Certificate of Authority |
English | |
| FIN352 | CCRC Biographical Affidavit Requirements Biographical Affidavit requirements for Continuing Care Retirement Communities (CCRCs) |
English | |
| FIN353 | Texas-Domestic Insurers Biographical Affidavit and Fingerprint Requirements Biographical Affidavit and Fingerprint requirements for Texas-Domestic Insurers |
English | |
| FIN354 | Foreign Insurers Biographical Affidavit and Fingerprint Requirements Biographical Affidavit and Fingerprint requirements for foreign insurers |
English | |
| FIN355 | HMO Biographical Affidavit and Fingerprint Requirements Biographical Affidavit and Fingerprint requirements for Health Maintenance Organizations (HMOs) |
English | |
| FIN356 | Texas Lloyds Insurers and Reciprocals Biographical Affidavit and Fingerprint Requirements Biographical Affidavit and Fingerprint Requirements for Texas Lloyds Insurers and Reciprocals |
English | |
| FIN357 | HMO Certificate of Authority Application Filing instruction |
English | |
| FIN358 | HMO D/B/A Filing Checklist Filing Instruction |
English | |
| FIN359 | HMO Home Office Change Checklist Filing Instruction |
English | |
| FIN360 | HMO- Name Change Checklist Filing Instruction |
English | |
| FIN361 | HMO Service Area Expansion Filing Instruction |
English | |
| FIN363 | HMO Merger Checklist Merger Checklist |
English | |
| FIN364 | HMO Dissolution Dissolution instructions |
English | |
| FIN365 | HMO Withdrawal Guidelines Withdrawal guidelines |
English | |
| FIN367 | Form A-212 (Reciprocal) Reciprocal companies complete for new or amended Certificate of Authority |
English | |
| FIN368 | Lloyds Incorporation Checklist Filing instruction |
English | |
| FIN369 | Form A-211 (Lloyds) Lloyds companies complete for new or amended Certificate of Authority |
English | |
| FIN370 | Charter Amendment Checklist for a Lloyds Plan Instruction for Lloyds amendments, including Underwriter Substitution, Attorney-in-Fact Change, Name Change or Home Office Change, or Increase in Guaranty Fund or Surplus Contribution |
English | |
| FIN371 | Attorney-in-Fact Change for Foreign Lloyds or Reciprocals Change checklist |
English | |
| FIN372 | Conversion of Lloyds to Stock P&C Insurer Filing instruction |
English | |
| FIN373 | MEWA Application for Initial and Permanent Certificate of Authority Filing instructions |
English | |
| FIN374 | MEWA Application to Do Business Checklist |
English | |
| FIN375 | MEWA Application Form for Initial Certificate of Authority Application Form |
English | |
| FIN376 | MEWA Officers, Directors, and Trustees Page Form |
English | |
| FIN377 | MEWA Service of Process Acknowledgment Form |
English | |
| FIN378 | MEWA Annual Filing Checklist Filing instruction |
English | |
| FIN381 | CCRC Filing Requirements for Certificate of Authority Filing instruction |
English | |
| FIN382 | CCRC 1 - Application for Certificate of Authority to do Business in Texas CCRC Application for Certificate of Authority to do business in Texas |
English | |
| FIN383 | CCRC 2 - Application for Approval by the Commissioner for Release of Loan Reserve Fund Escrow Account Amounts In Excess of that Allowed by Rule Application for Commissioners Approval to Release Loan Reserve Fund Escrow Amounts in Excess of that Allowed by rule |
English | |
| FIN384 | CCRC 3 - Officers and Directors Page CCRC Officers and Directors Page |
English | |
| FIN385 | CCRC 4 - Biographical Data Form for a For-Profit CCRC Biographical Data Form for a For-Profit CCRC |
English | |
| FIN386 | CCRC 4A - CCRC Biographical Affidavit for a Not-For-Profit CCRC CCRC Biographical Affidavit for a Not-For-Profit CCRC |
English | |
| FIN387 | CCRC 5 - Acknowledgement of Delivery of Disclosure Statement CCRC Acknowledgement of Delivery of Disclosure Statement |
English | |
| FIN388 | CCRC 6 - Format for Disclosure Statement Detailed instruction/format for submitting Disclosure Statement |
English | |
| FIN389 | CCRC Form #6A - CCRC Instructions for Preparation of Disclosure Statement Outline of Instructions for Preparation of CCRC Disclosure Statement |
English | |
| FIN390 | CCRC 7 - Change of Control Statement Guidelines and Statement |
English | |
| FIN391 | CCRC 8 - Certification of Changes to Disclosure Statement Certification form |
English | |
| FIN392 | CCRC 9 - Notice of Request to Release Entrance Fee Escrow Funds Attestation form |
English | |
| FIN393 | CCRC 10 - Notice of Request to Release Funds from the Reserve Fund Escrow Account Attestation form |
English | |
| FIN394 | CCRC 11 - Notice by Provider of Re-Payment of Previously Released Funds to the Reserve Fund Escrow Account Filing form |
English | |
| FIN395 | CCRC 12 - Affidavit of Re-payment of Previously Released Funds to the Reserve Fund Escrow Account Filing form |
English | |
| FIN396 | CCRC 13 - Notice of Lien Filing form |
English | |
| FIN397 | CCRC 14 - Calculations Concerning Conditions Filing form |
English | |
| FIN398 | CCRC Name Change Checklist CCRC Charter Amendment Checklist - Name Change |
English | |
| FIN399 | Joint Underwriting Association (JUA) Licensing (Initial or Renewal) Filing instruction |
English | |
| FIN400 | Joint Underwriting Association (JUA) Application for Certificate of Authority Filing form |
English | |
| FIN401 | Joint Underwriting Association (JUA) Supplemental Information (JUA-2A) Filing checklist JUA-2A |
English | |
| FIN402 | Joint Underwriting Association (JUA) Application for Amended Certificate of Authority (JUA-2B) Filing form JUA-2B |
English | |
| FIN403 | Continuing Care Retirement Community (CCRC) Release of Funds from Escrow Filing instructions |
English | |
| FIN404 | Workers Compensation Group Self-Insurance Coverage Acknowledgement of Indemnity Agreement Format Instructions |
English | |
| FIN413 | Texas Purchasing Group Registration Requirements Memo to Purchasing Groups Outlining Filing Requirements |
English | |
| FIN414 | Notification to the Commissioner for Registration as a Purchasing Group - Form PG1 Form PG1 - used for the initial registration of a group that intends to do business in Texas |
English | |
| FIN415 | Annual Agent Report for Risk Retention and Purchasing Groups - Form PG3 Form PG3 required to be filed by any agent for a purchasing group and shown on Form PG1 or Form PG1R |
English | |
| FIN416 | Appointment of Commissioner as Agent - Form RRG/PG C1 Form RRG/PG PC1 required for all purchasing groups. Notarized form appoints Commissioner of Insurance as agent for the purchasing group. |
English | |
| FIN417 | Renewal/Amendment of Purchasing Group Registration - Form PG1R Form PG1R - Form (notarized) and instructions used to report changes to the original registration and for annual renewal of Purchasing Groups, due by July 1. |
English | |
| FIN418 | Texas Risk Retention Group Registration Requirements Memorandum outlining the requirements and forms required for registering a Risk Retention Group in Texas |
English | |
| FIN419 | Registration of a Foreign/Alien Risk Retention Group - Form RRG-A-122 Form RRG-A-122 required for initial registration and renewal of a Risk Retention Group that intends to do business in Texas. |
English | |
| FIN420 | Risk Retention Group Registration Requirements Checklist Checklist provided to Risk Retention Groups to ensure all required documents are completed and submitted within required deadlines. |
English | |
| FIN421 | Evidence Filing Requirements for 2012 Surplus Lines Eligibility Memorandum highlighting the filing requirements and due dates for evidence to obtain or maintain Surplus Lines eligibility in Texas |
English | |
| FIN422 | Foreign (U.S. domiciled) Surplus Lines Insurers Filing Requirements/Checklist Instructions/Checklist for foreign (U.S. domiciled) Surplus Lines insurers that wish to obtain/maintain SL eligibility. See FIN421 for Memorandum to be utilized in conjunction with FIN422. |
English | |
| FIN423 | Alien (non-U.S. domiciled) Surplus Lines Insurers Filing Requirements/Checklist Instructions/Checklist for alien (non-U.S. domiciled) Surplus Lines insurers that wish to obtain/maintain SL eligibility. See Form FIN421 for Memorandum to be utilized in conjunction with this Form FIN423. |
English | |
| FIN424 | Surplus Lines Company Business Outline These are guidelines for Surplus Lines insurers when preparing the required 3 year business plan for Texas |
English | |
| FIN425 | Accredited/Trusteed Reinsurers Registration Requirements for 2012 Memorandum outlining 2012 filing requirements for reinsurers wanting to maintain their certification as Accredited or Trusteed Reinsurer. |
English | |
| FIN426 | Accredited/Trusteed Reinsurer Checklist, Form R-4 Form R-4 Checklist for Accredited/Trusteed Reinsurers listing filing requirements for reinsurers wanting to maintain their certification as Accredited or Trusteed Reinsurer. See FIN425 for memo with further instructions. |
English | |
| FIN427 | Submission for Reinsurance Accreditation, Form R-1 Form R-1 (notarized) submitted for Reinsurance Accreditation. See FIN425 for memo with further instructions. |
English | |
| FIN428 | Certificate of Assuming Insurer, Form R-3 Form R-3 (notarized form) Designates Commissioner of Insurance as Attorney for Service; submits to the COI to examine its books and records; submits to the jurisdiction of any court of competent jurisdiction in Texas for adjudication of any issues. |
English | |
| FIN429 | Accredited/Trusteed Reinsurer Business Plan Outline Guide to key elements that might be included in a 3-year business plan for Accredited/Trusteed Reinsurers. |
English | |
| FIN435 | Initial Statutory Deposit Checklist Checklist |
English | |
| FIN436 | Name Change for Securities on Deposit Checklist Checklist |
English | |
| FIN437 | Substituting Securities on Deposit Checklist Checklist |
English | |
| FIN438 | Withdrawal of Statutory Deposit Checklist Withdrawal Checklist |
English | |
| FIN439 | Texas Comptroller's Wiring Instructions Instructions |
English | |
| FIN440 | Instructions for Completing Securities Deposited Form 120 Instructions |
English | |
| FIN441 | Deposit Form 120 (FIN 441) Form for companies |
English | |
| FIN442 | Deposit Form 120 (FIN442) Form for insurance agencies |
English | |
| FIN443 | Deposit Form 120 (FIN443) Form for LLoyds companies |
English | |
| FIN444 | Instructions for Completing Form 121 Instructions |
English | |
| FIN445 | Securities Withdrawal Form 121 (FIN445) Form for companies |
English | |
| FIN446 | Withdrawal Form 121 (Agency) Withdrawal |
English | |
| FIN447 | Securities Withdrawal Form 121 (FIN447) Form for LLoyds |
English | |
| FIN448 | Instructions for Lloyds Placing Securities in Joint Control Instructions |
English | |
| FIN449 | Instructions for Companies Placing Securities in Joint Control Instructions |
English | |
| FIN450 | Joint Control Agreement Agreement |
English | |
| FIN451 | Instructions for HMOs Placing Securities on Deposit Instructions |
English | |
| FIN452 | HMO Pledge Letter Example Sample Letter |
English | |
| FIN453 | Declaration of Trust 1.10 (Policyholders Only) Declaration |
English | |
| FIN454 | Declaration of Trust 1.10 (Policyholders or Creditors) Declaration |
English | |
| FIN455 | Declaration of Trust 1.10 (State Specific Policyholders Only) Declaration |
English | |
| FIN456 | Declaration of Trust 1.10 (State Specific Policyholders or Creditors) Declaration |
English | |
| FIN457 | Declaration of Trust 8.24 (Mexican Casualty Companies) Declaration |
English | |
| FIN458 | Declaration of Trust 9.12 (Title Companies) Declaration - (Electronic Form Not Yet Available) |
English | |
| FIN459 | Declaration of Trust 21.46 (Retaliatory) Declaration - (Electronic Form Not Yet Available) |
English | |
| FIN460 | Declaration of Trust 861.252a (Domestic P&C Companies), formerly 8.05-1 Declaration |
English | |
| FIN461 | Declaration of Trust 861.252b (Foreign P&C Companies) Declaration |
English | |
| FIN462 | Workers' Comp Self-Insured Group Pledge/Trust Document |
English | |
| FIN463 | CD Free of Liens Form |
English | |
| FIN464 | Bond of Administrator or Service Company For A Workers' Compensation Self-Insured Group Format Instructions |
English | |
| FIN465 | Workers Compensation Self-Insurance Group Application Application for Certificate of Approval to Conduct Workers Compensation Self-Insurance Group (SIG) Business |
English | |
| FIN466 | Workers Compensation Self-Insurance Group (SIG) Application Checklist Application Checklist for Workers Compensation Self-Insurance Groups (SIG) |
English | |
| FIN467 | Workers Compensation Self-Insurance Group (SIG) Employer Membership Form Employer Membership Form for Workers Compensation Self-Insurance Groups |
English | |
| FIN468 | Workers Compensation Self-Insurance Group (SIG) Notification Form Mandatory Notification to the Commissioner of Insurance Regarding Any One of a Variety of Possible Changes that a Workers Compensation Self-Insurance Group Makes |
English | |
| FIN469 | Workers Compensation Self-Insurance Group (SIG) Termination of Certificate of Approval Checklist Checklist for a Workers Compensation Self-Insurance Group (SIG) to Apply for Termination of its Certificate of Approval |
English | |
| FIN470 | Workers Compensation Self-Insurance Group (SIG) Merger Checklist Checklist for a Workers Compensation Self-Insurance Group (SIG) to Merge with Another SIG Engaged in the Same or Similar Type of Business |
English | |
| FIN471 | Workers Compensation Self-Insurance Group (SIG) 5% Investments Instruction for a Workers Compensation Self-Insurance Group (SIG) Regarding Authorized Investments for Meeting Minimum Capital and Surplus and Reserves |
English | |
| FIN472 | Workers Compensation Self-Insurance Group (SIG) Hazardous Financial Condition Notice Instruction and Checklist for a Workers Compensation Self-Insurance Group (SIG) should it become Insolvent or Discover a Hazardous Financial Condition |
English | |
| FIN473 | Workers Compensation Self-Insurance Group (SIG) Changes to Administrator/Service Company Agreements Checklist Checklist for a Workers Compensation Self-Insurance Group (SIG) if there are any Changes to Agreements or New Agreements are Entered Into with An Administrator/Service Company |
English | |
| FIN474 | Workers Compensation Self-Insurance Group (SIG) Change in Security for Incurred Liabilities Form Security Deposit Instructions for a Workers Compensation Self-Insurance Group (SIG) |
English | |
| FIN475 | Workers Compensation Self-Insurance Group (SIG) Change in Performance or Fidelity Bond Checklist Checklist for a Workers Compensation Self-Insurance Group (SIG) for a Change in Performance or Fidelity Bond |
English | |
| FIN476 | Workers Compensation Self-Insurance Group (SIG) Changes to Corporate Governance Documents Checklist Checklist for a Workers Compensation Self-Insurance Group (SIG) to Make a Change to its Corporate Governance Documents, Including By-Laws, Articles of Association, Incorporation, or other Documentation used to Verify the Existence of the SIG and/or Trust |
English | |
| FIN477 | Workers Compensation Self-Insurance Group (SIG) Excess Insurance Checklist Checklist for a Workers Compensation Self-Insurance Group (SIG) to Establish Excess Insurance for Losses |
English | |
| FIN478 | Workers Compensation Self-Insurance Group (SIG) Financial Pro Forma Financial Pro Forma for a Workers Compensation Self-Insurance Group (SIG) |
English | |
| FIN479 | Workers Compensation Self-Insurance Group (SIG) Movement of Books and Records Checklist Checklist for a Workers Compensation Self-Insurance Group (SIG) to Request to Move its Books and Records out of Texas |
English | |
| FIN480 | Workers Compensation Self-Insurance Group (SIG) Increase or Decrease in Membership Checklist Checklist for a Workers Compensation Self-Insurance Group (SIG) if there is an Increase or Decrease in Membership |
English |
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