ADMITTED COMPANY
TRANSACTIONS |
DOWNLOAD FILE
(Word/Excel) |
PDF FILE |
Admission
NAIC UCAA Expansion Application |
Form:
Name Application (fin300nameapp.doc)
USE THIS FORM ONLY FOR NON-UCAA TRANSACTIONS |
Form:
Name Application (fin300nameapp.pdf)
USE THIS FORM ONLY FOR NON-UCAA TRANSACTIONS |
Alien, U.S. Branch Admission
NAIC UCAA Primary Application |
Form:
Attorney for Service (fin312attyserv.doc)
Biographical Affidavit (fin311bioaff.doc)
Name Application (fin300nameapp.doc)
Officers and Directors Page (fin306offdirpg.doc)
USE THESE FORMS ONLY FOR NON-UCAA TRANSACTIONS |
Form:
Attorney for Service (fin312attyserv.pdf)
Biographical Affidavit (fin311bioaff.pdf)
Name Application (fin300nameapp.pdf)
Officers and Directors Page (fin306offdirpg.pdf)
USE THESE FORMS ONLY FOR NON-UCAA TRANSACTIONS |
Amended Articles of Incorporation
NEED ONLY SUBMIT
APPROPRIATE FORMS
Adding/Deleting Lines of Business:
NAIC UCAA Corporate Amendments |
Checklist:
Domestic Life Charter Amendment Checklist (fin332lifechrt.doc)
Domestic P&C Charter Amendment Checklist (fin333pcchrt.doc)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.doc)
Capital Changes Worksheet (fin320capitlchg.doc)
Name Application (fin300nameapp.doc)
USE THESE FORMS ONLY FOR NON-UCAA TRANSACTIONS |
Checklist:
Domestic Life Charter Amendment Checklist (fin332lifechrtr.pdf)
Domestic P&C Charter Amendment Checklist (fin333pcchrtr.pdf)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.pdf)
Capital Changes Worksheet (fin320capitlchg.pdf)
Name Application (fin300nameapp.pdf)
USE THESE FORMS ONLY FOR NON-UCAA TRANSACTIONS |
Amended Certificate of Authority
NEED ONLY SUBMIT
APPROPRIATE FORMS
Adding/Deleting Lines of Business:
NAIC UCAA Corporate Amendments |
Checklist:
Application to Amend TX Certificate of Authority (fin340amendtxca.doc)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.doc)
Name Application (fin300nameapp.doc)
USE THESE FORMS ONLY FOR NON-UCAA TRANSACTIONS |
Checklist:
Application to Amend TX Certificate of Authority (fin340amendtxca.pdf)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.pdf)
Name Application (fin300nameapp.pdf)
USE THESE FORMS ONLY FOR NON-UCAA TRANSACTIONS |
|
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.doc) |
Checklist:
Assumed Name Certificate (fin305assmname.pdf) |
Attorney-for-Service Change
Requires a $25.00 Filing Fee |
Form:
Attorney for Service (fin312attyserv.doc) |
Form:
Attorney for Service (fin312attyserv.pdf) |
| Attorney-in-Fact Change |
Checklist:
Attorney-in-Fact Change Checklist for Foreign Lloyds or Reciprocals (fin371foraif.doc)
Form:
Attorney-in-Fact and Underwriters Page (fin307aifundpg.doc) |
Checklist:
Attorney-in-Fact Change Checklist for Foreign Lloyds or Reciprocals (fin371foraif.pdf)
Form:
Attorney-in-Fact and Underwriters Page (fin307aifundpg.pdf) |
Biographical
(Domestic Companies)
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 |
Please use the NAIC UCAA Application Forms link and select NAIC Biographical Affidavit(Word) from the list |
Please use the NAIC UCAA Application Forms link and select NAIC Biographical Affidavit(PDF) from the list |
Books and Records - Moving Out of Texas (TIC 804.102)
File with Financial Analysis & Examinations |
Contact the Financial Analysis & Examinations division to request the Checklist and Form for moving books and records: |
Contact the Financial Analysis & Examinations division to request the Checklist and Form for moving books and records:
|
| Business Plans |
Checklist:
Abbreviated Business Plan Guidelines (fin328abbrvbus.doc)
Life, Accident & Health Business Plan (fin326lifebuspl.doc)
Property & Casualty Business Plan (fin327pcbuspl.doc) |
Checklist:
Abbreviated Business Plan Guidelines (fin328abbrvbus.pdf)
Life, Accident & Health Business Plan (fin326lifebuspl.pdf)
Property & Casualty Business Plan (fin327pcbuspl.pdf) |
CCRC Disclosure Statement
NOTE: Mail Code is 305-2C |
Checklist:
CCRC 6A - Instructions for Preparation of Disclosure Statement (fin389ccrcfrm6a.doc)
Form:
CCRC 6 - Format of Disclosure Statement (fin388ccrcfrm6.doc)
CCRC 5 - Acknowledgement of Delivery of Disclosure Statement (fin387ccrcfrm5.doc)
CCRC 8 - Certification of Changes to Disclosure Statement (fin391ccrcfrm8.doc) |
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
NOTE: Mail Code is 305-2C |
Checklist:
CCRC Release Escrow Checklist (fin403relescrow.doc)
Form:
CCRC 9 - Notice of Request to Release Entrance Fee Escrow Funds (fin392ccrcfrm9.doc)
CCRC 2 - Application for Release of Loan Reserve Fund (fin383ccrcfrm2.doc)
CCRC 10 - Notice of Request to Release Funds from the Reserve Fund Escrow Account (fin393ccrcfrm10.doc) |
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
NOTE: Mail Code is 305-2C |
Checklist:
CCRC Certificate of Authority Application Filing Requirements (fin381ccrccaapp.doc)
CCRC 4A - Biographical Affidavit Instructions (fin386ccrcfrm4a.doc)
Form:
CCRC 1 - Certificate of Authority Application (fin382ccrcfrm1.doc)
CCRC 3 - Officers and Directors Page (fin384ccrcfrm3.doc)
CCRC 4 - Biographical Data Form (fin385ccrcfrm4.doc)
|
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
NOTE: Mail Code is 305-2C |
Form:
CCRC 7 - Change of Control Statement (fin390ccrcfrm7.doc)
CCRC 13 - Notice of Lien (fin396ccrcfrm13.doc)
CCRC 14 - Calculations Concerning Conditions (fin397ccrcfrm14.doc) |
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
NOTE: Mail Code is 305-2C |
Checklist:
CCRC Charter Amendment - Name Change (fin398ccrcnc.doc) |
Checklist:
CCRC Charter Amendment - Name Change (fin398ccrcnc.pdf) |
CCRC Repayment of Previously Released Funds
NOTE: Mail Code is 305-2C |
Form:
CCRC 11 - Notice by Provider of Repayment of Previously Released Funds to the Reserve Fund Escrow Account (fin394ccrcfrm11.doc)
CCRC 12 - Affidavit of Repayment of Previously Released Funds to the Reserve Fund Escrow Account (fin395ccrcfrm12.doc) |
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 CofA (fin352forcancel.doc) |
Form:
Cancellation of a Foreign Insurer's TX CofA (fin352forcancel.pdf) |
| Capital/Shares Certificate |
Checklist:
Foreign Charter Amendment Checklist - Increase Authorized or Stated Capital (fin337incrscap.doc) |
Checklist:
Foreign Charter Amendment Checklist - Increase Authorized or Stated Capital (fin337incrscap.pdf) |
| Consent Order Waiver |
Form:
Consent Order Waiver Document (fin321cowaiver.doc) |
Form:
Consent Order Waiver Document (fin321cowaiver.pdf) |
Conversion/Demutualization
NEED ONLY SUBMIT
APPROPRIATE FORMS
|
Checklist:
Demutualization or Conversion of a Foreign Insurer - Checklist (fin342forcnvrt.doc)
Conversion of a Domestic Mutual Insurer to Domestic Stock Insurer - Checklist (fin343domcnvrt.doc)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.doc)
Name Application (fin300nameapp.doc)
Life/Health Application for Certificate of Authority (fin301lifecaapp.doc)
P&C Application for Certificate of Authority (fin303pccaapp.doc)
Standard Coverages Page (fin304standcov.doc)
Application to Amend TX Certificate of Authority (fin340amendtxca.doc) |
Checklist:
Demutualization or Conversion of a Foreign Insurer - Checklist (fin342forcnvrt.pdf)
Conversion of a Domestic Mutual Insurer to Domestic Stock Insurer - Checklist (fin343domcnvrt.pdf)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.pdf)
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.doc)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.doc) |
Checklist:
Voluntary Dissolution (fin351dissolve.pdf)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.pdf) |
Domestication
See Alien, U.S. Branch
Admission for additional
checklists & forms
NEED ONLY SUBMIT
APPROPRIATE FORMS |
Checklist:
Procedures for Domestication of a U.S. Branch of an Alien Insurer (fin331domusbch.doc) |
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 (fin310lostca.doc)
USE THIS FORM ONLY FOR NON-UCAA TRANSACTIONS |
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.pdf)
USE THIS FORM ONLY FOR NON-UCAA TRANSACTIONS |
Incorporation
NAIC UCAA Primary Application |
Form:
Name Application (fin300nameapp.doc)
USE THIS FORM ONLY FOR NON-UCAA TRANSACTIONS |
Form:
Name Application (fin300nameapp.pdf)
USE THIS FORM ONLY FOR NON-UCAA TRANSACTIONS |
JUA Issuance or Renewal
Certificate of Authority |
Checklist:
Joint Underwriting Association Licensing - Initial or Renewal (fin399jualicens.doc) |
Checklist:
Joint Underwriting Association Licensing - Initial or Renewal (fin399jualicens.pdf) |
| Lloyds Incorporation |
Checklist:
Procedures for the Original Incorporation of a Lloyds Co. (fin368llydsinc.doc)
Form:
Form A-211 Lloyds Underwriters (fin369llyda211.doc) |
Checklist:
Procedures for the Original Incorporation of a Lloyds Co. (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.
|
Checklist:
Merger Involving at Least One Domestic Insurer (fin341dommerge.doc)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.doc)
USE THIS FORM ONLY FOR NON-UCAA TRANSACTIONS |
Checklist:
Merger Involving at Least One Domestic Insurer (fin341dommerge.pdf)
Assumption Certificates Checklist - Life Div. (lhl356asckac.pdf)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.pdf)
USE THIS FORM ONLY FOR NON-UCAA TRANSACTIONS |
| Mexican Casualty Admission |
Checklist:
Mexican Casualty Admission Checklist (fin330mexcasadm.doc)
Form:
Attorney for Service (fin312attyserv.doc)
Biographical Affidavit (fin311bioaff.doc)
Name Application (fin300nameapp.doc)
Officers and Directors Page (fin306offdirpg.doc)
P&C Application for Certificate of Authority (fin303pccaapp.doc)
Standard Coverages Page (fin304standcov.doc) |
Checklist:
Mexican Casualty Admission Checklist (fin330mexcasadm.pdf)
Form:
Attorney for Service (fin312attyserv.pdf)
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.doc) |
Checklist:
MEWA Annual Filing Checklist (fin378mewaannl.pdf) |
MEWA Initial or Final
Certificate of Authority |
Checklist:
Instructions for Certificate of Authority - MEWA (fin373mewacaapp.doc) |
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.doc) |
Form:
Mortgage Guaranty Affidavit (fin316mortguar.pdf) |
Name Change
NAIC UCAA Corporate Amendments
For questions regarding the Company Name Change Checklist (Name Change Endorsement Requirements), contact the Life Group at (512)322-3406.
|
Checklist:
Company Name Change Checklist - Life Div. (lhl357ascknc.pdf)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.doc)
Name Application (fin300nameapp.doc)
USE THESE FORMS ONLY FOR NON-UCAA TRANSACTIONS |
Checklist:
Company Name Change Checklist - Life Div. (lhl357ascknc.pdf)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.pdf)
Name Application (fin300nameapp.pdf)
USE THESE FORMS ONLY FOR NON-UCAA TRANSACTIONS |
| Notifications to Texas Dept. 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 Company Licensing & Registration |
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.doc) |
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.doc)
USE THIS FORM ONLY FOR NON-UCAA TRANSACTIONS |
Form:
Name Application (fin300nameapp.pdf)
USE THIS FORM ONLY FOR NON-UCAA TRANSACTIONS |
Reinsurance of a Chapter 14
Co. Into a Chapter 22 Co. |
Checklist:
Documents Required for Reinsurance of a Mutual Assessment Co. into a Stipulated Premium Co. (fin347reinlmastip.doc) |
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 Ins. Market Subsequent to Filing a Withdrawal Plan (fin350reentertx.doc) |
Checklist:
Companies Re-entering TX Ins. Market Subsequent to Filing a Withdrawal Plan (fin350reentertx.pdf) |
| Retaliatory Fees |
Checklist:
Retaliatory Fees and Requirements (fin325retalreqs.doc)
Includes requirements for the following: Texas Fees, Deposits and Bonds, Premium Taxes |
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.doc)
Instructions for Completing Form 121 (fin444instr121.doc)
Initial Statutory Deposit Checklist (fin435depositck.doc)
Name Change Checklist for Statutory Deposit (fin436namechgck.doc)
Substitution of Securities on Deposit Checklist (fin437substitut.doc)
Withdrawal of Statutory Deposit Checklist (fin438secwdraw.doc)
Texas Comptroller's Wiring Instructions (fin439wiring.doc)
Form:
Form 120 Securities Deposited (fin441form120.doc)
Form 121 Securities Withdrawn (fin445form121.doc)
Declaration of Trust 1.10 - Policyholders or Creditors (fin454dt110porc.doc)
Declaration of Trust 861.252a - Domestic P & C Companies (fin460dt861252a.doc) |
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.doc)
Instructions for Completing Form 121 (fin444instr121.doc)
Form:
Joint Control Agreement (fin450jointcntl.doc)
Form 120 Securities Deposited - Lloyds (fin443form120ll.doc)
Form 121 Securities Withdrawn - Lloyds (fin447form121ll.doc) |
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 (fin346forreins.doc)
Assumption Certificates Checklist - Life Div. (lhl356asckac.pdf)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.doc) |
Checklist:
Total & Partial Reinsurance Agreements Involving a Foreign Company - Checklist (fin346forreins.pdf)
Assumption Certificates Checklist - Life Div. (lhl356asckac.pdf)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.pdf) |
Total & Partial Reinsurance
Involving TX Domestic
For questions regarding the Assumption Certificates Checklist, contact the Life Group at (512)322-3406.
|
Checklist:
Total & Partial Reinsurance Agreements Involving a Domestic Company - Checklist (fin345domreins.doc)
Assumption Certificates Checklist - Life Div. (lhl356asckac.pdf)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.doc)
|
Checklist:
Total & Partial Reinsurance Agreements Involving a Domestic Company - Checklist (fin345domreins.pdf)
Assumption Certificates Checklist - Life Div. (lhl356asckac.pdf)
Form:
Affidavit of Lost Certificate of Authority (fin310lostca.pdf) |
| Underwriter Substitution |
Checklist:
Charter Amendment Checklist for a Lloyds Plan (fin370llydamend.doc)
Form:
Form A-211 Lloyds Underwriters (fin369llyda211.doc) |
Checklist:
Charter Amendment Checklist for a Lloyds Plan (fin370llydamend.pdf)
Form:
Form A-211 Lloyds Underwriters (fin369llyda211.pdf) |
| Withdrawal |
Checklist:
Withdrawal Guidelines (fin349withdraw.doc) |
Checklist:
Withdrawal Guidelines (fin349withdraw.pdf) |
Texas Department of Insurance
