Financial - Company Licensing and Registration Forms Listing
For more information regarding any of the topics below, go to the Company Licensing and Registration home page.
PEO Self-Funded Health Plans
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| TDI Form Number | Description | File Format | Language |
|---|---|---|---|
| FIN311 |
Biographical Affidavit Biographical Affidavit form to be completed by certain officers and directors of insurance companies; compliance with statute |
English | |
| FIN321 |
Company Licensing Fee Transmittal Form |
English | |
| FIN407 |
Statutory Deposit Transaction Form Statutory Deposit Transaction Form is submitted when a securities is deposited or withdrawn. |
English | |
| FIN409 |
Texas PEO Quarterly Report Quarterly report filed for PEO self-funded employee health benefit plans. |
EXCEL | English |
| FIN410 |
Texas PEO Annual Report Annual financial report filed by PEO self-funded health benefit plans. |
EXCEL | English |
| FIN411 |
Financial Projections for Self-Funded PEO Plans Financial projections to be submitted for a PEO self-funded health benefit plan. |
EXCEL | English |
| FIN412 |
Professional Employer Organization Application for a Certificate of Approval to Sponsor a Client Employer Health Benefit Plan Certificate of approval application and checklist for a PEO sponsored Client Employer Health Benefit Plan |
English | |
| FIN453 |
Declaration of Trust Form to be executed for securities held on deposit. |
English |
For more information, contact: CompanyLicense@tdi.texas.gov