Admitted Company Transactions, Forms, and Checklists
- Company Licensing & Registration Home Page
- FAST Pass Form (for electonic fingerprint appointment)
- Fingerprint Card Scan Authorization Form
- HMO Transactions
- Surplus Lines, Purchasing Group, Accredited/Trusteed Reinsurer and Risk Retention Group Transactions
- Viatical and Life Settlement Registrations
- Workers Compensation Self-Insurance Groups (SIGs)
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| ADMITTED COMPANY TRANSACTIONS |
DOWNLOAD FILE (Word/Excel) |
PDF FILE |
|---|---|---|
| Admission NAIC UCAA Expansion Application |
Form: Name Application (fin300nameapp.pdf) | |
| Alien, U.S. Branch Admission NAIC UCAA Primary Application |
Form: Attorney for Service Biographical Affidavit (fin311bioaff.pdf) Name Application (fin300nameapp.pdf) Officers and Directors Page (fin306offdirpg.pdf) | |
| Amended Articles of Incorporation ONLY SUBMIT APPROPRIATE FORMS Adding/Deleting Lines of Business: NAIC UCAA Corporate Amendments |
Checklist: Domestic Life Charter Amendment Checklist (fin332lifechrtr.pdf) Domestic P&C Charter Amendment Checklist (fin333pcchrtr.pdf) Form: Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15) Capital Changes Worksheet (fin320capitlchg.pdf) Name Application (fin300nameapp.pdf) USE THESE FORMS ONLY FOR NON-UCAA TRANSACTIONS | |
| Amended Certificate of Authority ONLY SUBMIT APPROPRIATE FORMS Adding/Deleting Lines of Business: NAIC UCAA Corporate Amendments |
Checklist: Application to Amend TX Certificate of Authority (fin340amendtxca.pdf) Form: Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15)Name Application (fin300nameapp.pdf) | |
| Amendment of By-Laws When changes occur to by-laws for ALL Foreign Companies and ONLY Domestic Fraternals, County Mutuals, Local Mutual Aids, Local Mutual Burials, Farm Mutuals, or Title Companies |
No checklist or form File with Company Licensing the full text of by-laws (including amendments), certified by Corporate Secretary. All Foreign Companies must file pursuant to TIC 982.104 FEE IS RETALIATORY |
No checklist or form |
| Assumed Name | Checklist: Assumed Name Certificate (fin305assmname.pdf) | |
| Attorney-for-Service Change Requires a $25.00 Filing Fee |
Form: Attorney for Service |
Form: Attorney for Service |
| Attorney-in-Fact Change | Checklist: Attorney-in-Fact Change Checklist for Foreign Lloyds or Reciprocals (fin371foraif.pdf) Form: Attorney-in-Fact and Underwriters Page (fin307aifundpg.pdf) | |
| Biographical Affidavit and Fingerprint Card Requirements NAIC UCAA Application Forms For use when change occurs in executive officers & directors as listed on the company's officer & director page, or underwriters, or attorney-in-fact. |
Checklist: Biographical Affidavit and Fingerprint Card Checklist for Domestic, Foreign, and HMO Companies Form: Please use the NAIC UCAA Application Forms link and select NAIC Biographical Affidavit (Word) from the list. Refer to Commissioner's Bulletin #B-0045-06 for Texas fingerprint requirements. |
Checklist: Biographical Affidavit and Fingerprint Card Checklist for Domestic, Foreign, and HMO Companies Form: Please use the NAIC UCAA Application Forms link and select NAIC Biographical Affidavit (PDF) from the list. Refer to Commissioner's Bulletin #B-0045-06 for Texas fingerprint requirements. |
| Books and Records - Moving Out of Texas (TIC 804.102) File with the Financial Analysis Division (FinancialAnalysis@tdi.state.tx.us) |
Contact the Financial Analysis Divsion to request the Checklist and Form for moving books and records. | Contact the Financial Analysis Division to request the Checklist and Form for moving books and records. |
| Business Plans | Checklist: Abbreviated Business Plan Guidelines (fin328abbrvbus.pdf) Life, Accident & Health Business Plan (fin326lifebuspl.pdf) Property & Casualty Business Plan (fin327pcbuspl.pdf) | |
| CCRC Disclosure Statement |
Checklist: CCRC 6A - Instructions for Preparation of Disclosure Statement (fin389ccrcfrm6a.pdf) Form: CCRC 6 - Format of Disclosure Statement (fin388ccrcfrm6.pdf) CCRC 5 - Acknowledgement of Delivery of Disclosure Statement (fin387ccrcfrm5.pdf) CCRC 8 - Certification of Changes to Disclosure Statement (fin391ccrcfrm8.pdf) | |
| CCRC Escrow Release |
Checklist: CCRC Release Escrow Checklist (fin403relescrow.pdf) Form: CCRC 9 - Notice of Request to Release Entrance Fee Escrow Funds (fin392ccrcfrm9.pdf) CCRC 2 - Application for Release of Loan Reserve Fund (fin383ccrcfrm2.pdf) CCRC 10 - Notice of Request to Release Funds from the Reserve Fund Escrow Account (fin393ccrcfrm10.pdf) | |
| CCRC Licensing |
Checklist: CCRC Certificate of Authority Application Filing Requirements (fin381ccrccaapp.pdf) CCRC 4A - Biographical Affidavit Instructions (fin386ccrcfrm4a.pdf) Form: CCRC 1 - Certificate of Authority Application (fin382ccrcfrm1.pdf) CCRC 3 - Officers and Directors Page (fin384ccrcfrm3.pdf) CCRC 4 - Biographical Data Form (fin385ccrcfrm4.pdf) | |
| CCRC Miscellaneous |
Form: CCRC 7 - Change of Control Statement (fin390ccrcfrm7.pdf) CCRC 13 - Notice of Lien (fin396ccrcfrm13.pdf) CCRC 14 - Calculations Concerning Conditions (fin397ccrcfrm14.pdf) | |
| CCRC Name Change |
Checklist: CCRC Charter Amendment - Name Change (fin398ccrcnc.pdf) | |
| CCRC Repayment of Previously Released Funds |
Form: CCRC 11 - Notice by Provider of Repayment of Previously Released Funds to the Reserve Fund Escrow Account (fin394ccrcfrm11.pdf) CCRC 12 - Affidavit of Repayment of Previously Released Funds to the Reserve Fund Escrow Account (fin395ccrcfrm12.pdf) | |
| Cancel Certificate of Authority | Form: Cancellation of a Foreign Insurer's TX Certificate of Authority |
Form: Cancellation of a Foreign Insurer's TX Certificate of Authority |
| Capital/Shares Certificate | Checklist: Foreign Charter Amendment Checklist - Increase Authorized or Stated Capital (fin337incrscap.pdf) | |
| Conversion/Demutualization ONLY SUBMIT APPROPRIATE FORMS |
Checklist: Demutualization or Conversion of a Foreign Insurer (fin342forcnvrt.pdf) Conversion of a Domestic Mutual Insurer to Domestic Stock Insurer (fin343domcnvrt.pdf) Form: Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15)Name Application (fin300nameapp.pdf) Life/Health Application for Certificate of Authority (fin301lifecaapp.pdf) P&C Application for Certificate of Authority (fin303pccaapp.pdf) Standard Coverages Page (fin304standcov.pdf) Application to Amend TX Certificate of Authority (fin340amendtxca.pdf) | |
| Dissolution | Checklist: Voluntary Dissolution (fin351dissolve.pdf) Form: Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15) | |
| Domestication See Alien, U.S. Branch Admission for additional checklists & forms ONLY SUBMIT APPROPRIATE FORMS |
Checklist: Procedures for Domestication of a U.S. Branch of an Alien Insurer (fin331domusbch.pdf) | |
| Home Office Change NAIC UCAA Corporate Amendments |
Form: Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15) |
Form: Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15) |
| Incorporation NAIC UCAA Primary Application |
Form: Name Application (fin300nameapp.pdf) | |
| JUA Issuance or Renewal Certificate of Authority |
Checklist: Joint Underwriting Association Licensing - Initial or Renewal (fin399jualicens.pdf) | |
| Lloyds Incorporation | Checklist: Procedures for the Original Incorporation of a Lloyds Company (fin368llydsinc.pdf) Form: Form A-211 Lloyds Underwriters (fin369llyda211.pdf) | |
| Merger For mergers involving two Foreign insurers go to: NAIC UCAA Corporate Amendments (see Section 7) For questions regarding the Assumption Certificates Checklist, contact the Life Group at (512) 322-3406. (lhl356asckac.pdf) |
Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15) |
Checklist: Merger Involving at Least One Domestic Insurer (fin341dommerge.pdf) Form: Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15) |
| Mexican Casualty Admission | Checklist: Mexican Casualty Admission Checklist (fin330mexcasadm.pdf) Form: Attorney for Service Biographical Affidavit (fin311bioaff.pdf) Name Application (fin300nameapp.pdf) Officers and Directors Page (fin306offdirpg.pdf) P&C Application for Certificate of Authority (fin303pccaapp.pdf) Standard Coverages Page (fin304standcov.pdf) | |
| MEWA Annual | Checklist: MEWA Annual Filing Checklist (fin378mewaannl.pdf) | |
| MEWA Initial or Final Certificate of Authority |
Checklist: Instructions for Certificate of Authority -MEWA (fin373mewacaapp.pdf) | |
| Minutes of Annual or Special Meeting of Board of Directors |
No checklist or form Statewide Mutual Assessment companies, Local Mutual Burials, Local Mutual Aids, County Mutuals, must supply this document when an annual or special meeting is held |
No checklist or form |
| Mortgage Guaranty Insurance | Form: Mortgage Guaranty Affidavit (fin316mortguar.pdf) | |
| Name Change NAIC UCAA Corporate Amendments |
For questions regarding the Name Change Endorsement Requirements), contact Life Group at (512) 322-3406. (lhl357ascknc.pdf) |
Form: Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15) Name Application (fin300nameapp.pdf) For questions regarding the Name Change Endorsement Requirements), contact Life Group at (512) 322-3406. (lhl357ascknc.pdf) |
| Notifications to Texas Department of Insurance of Penalties or Disciplinary Actions in Other States |
No checklist or form When a Company's license is suspended or revoked or a fine is levied by another regulatory authority, submit notification to the Company Licensing & Registration Division, MC 305-2C |
No checklist or form Submit a copy of the action, executed by Regulatory Authority and Company. Please include copy of payment made, if applicable. |
| Reciprocal Exchanges | Form: Form A-212 Reciprocal or Inter-Insurance Exchanges (fin367recipa212.pdf) | |
| Redomestication NAIC UCAA Corporate Amendments If Redomesticating to Texas, please refer to the NAIC UCAA Primary Application |
Form: Name Application (fin300nameapp.pdf) | |
| Reinsurance of a Chapter 14 Company into a Chapter 22 Company |
Checklist: Documents Required for Reinsurance of a Mutual Assessment Co. into a Stipulated Premium Co. (fin347reinlmastip.pdf) | |
| Resume Writing Lines | Checklist: Companies re-entering TX Insurance Market Subsequent to Filing a Withdrawal Plan (fin350reentertx.pdf) | |
| Retaliatory Fees | Checklist: Retaliatory Fees and Requirements (fin325retalreqs.pdf) Includes requirements for the following: Texas Fees, Deposits and Bonds, Premium Taxes | |
| Statutory Deposit | Checklist: Instructions for Completing Form 120 (fin440instr120.pdf) Instructions for Completing Form 121 (fin444instr121.pdf) Initial Statutory Deposit Checklist (fin435depositck.pdf) Name Change Checklist for Statutory Deposit (fin436namechgck.pdf) Substitution of Securities on Deposit Checklist (fin437substitut.pdf) Withdrawal of Statutory Deposit Checklist (fin438secwdraw.pdf) Texas Comptroller's Wiring Instructions (fin439wiring.pdf) Form: Form 120 Securities Deposited (fin441form120.pdf) Form 121 Securities Withdrawn (fin445form121.pdf) Declaration of Trust 1.10 - Policyholders or Creditors (fin454dt110porc.pdf) Declaration of Trust 861.252a - Domestic P&C Companies (fin460dt861252a.pdf) | |
| Statutory Deposit - Lloyds | Checklist: Instructions for Lloyds Placing Securities in Joint Control (fin448lloydsjca.pdf) Instructions for Completing Form 121 (fin444instr121.pdf) Form: Joint Control Agreement (fin450jointcntl.pdf) Form 120 Securities Deposited - Lloyds (fin443form120ll.pdf) Form 121 Securities Withdrawn - Lloyds (fin447form121ll.pdf) | |
| Total & Partial Reinsurance Involving Foreign Ins. Co. For questions regarding the Assumption Certificates Checklist, contact the Life Group at (512) 322-3406. |
Checklist: Total & Partial Reinsurance Agreements Involving a Foreign Company - Checklist Form: Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15) |
Checklist: Total & Partial Reinsurance Agreements Involving a Foreign Company - Checklist (fin346forreins.pdf) Form: Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15) |
| Total & Partial Reinsurance Involving TX Domestic For questions regarding the Assumption Certificates Checklist, contact the Life Group at (512) 322-3406. (lhl356asckac.pdf) |
Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15) |
Checklist: Total & Partial Reinsurance Agreements Involving a Domestic Company - Checklist (fin345domreins.pdf) Form: Affidavit of Lost Certificate of Authority (NAIC UCAA Form 15) |
| Underwriter Substitution | Checklist: Charter Amendment Checklist for a Lloyds Plan (fin370llydamend.pdf) Form: Form A-211 Lloyds Underwriters (fin369llyda211.pdf) | |
| Withdrawal | Checklist: Withdrawal Guidelines (fin349withdraw.pdf) |
For more information contact:
Last updated: 02/10/2012
