TDI Licensing Forms Listing from the Texas Department of Insurance

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Agent/Adjuster Forms

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Application Forms | Continuing Education Forms | Information Update Forms
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This is one of several pages linking to a central repository of forms used by TDI customers. Use the search or Forms by Program/Division links on the Forms Home Page or scan through our form listings.

Web Enabled Agent/Adjuster Application Forms
TDI Form Number	Description	File Format	Language
	Electronic Non-resident Application - fill in and send on-line. (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 Agents and Adjusters - fill in and send on-line. (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 Format	Language
FastForm for electronic fingerprint appointment	FastPass Form for electronic fingerprint appointment	PDF	English
FastForm for fingerprint card	Fingerprint Card Scan Authorization Form to submit with fingerprint card	PDF	English
LHL202	Licensing Corporate Insurance Agents Bond (AKA Insurance Agency Bond) Method of showing proof of financial responsibility to obtain corporate license.	PDF	English
LHL206	Licensing - Individual Application for Insurance License Used by individuals not required to qualify by examination. Previously, form number LI011.	PDF	English
LHL249	Licensing Application for Insurance Agency License Used by corporations, partnerships, depository institions and other business entity eligible for an insurance agency license under the provisions of the Texas Insurance Code.	PDF	English
LHL250	Annual Nonresident Public Insurance Adjuster Affidavit Fill-in On Screen and Print	PDF	English
LHL256	Licensing Public Insurance Adjuster Bond 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
li004	Speciality Insurance License Application	PDF	English

Continuing Education Forms
TDI Form Number	Description	File Format	Language
LHL212	Application for Provider Registration Application to become a CE provider.	PDF	English
LHL213	Application for Course Certification Application for certification of CE course.	PDF	English
LHL216	CE Exemption or Extension Application for licensee CE Exemption or Extension.	PDF	English
LHL240	Course Assignment Form Allows an existing provider to assign the right to give its course to another existing provider. Both must have active provider registrations.	PDF	English
LHL257	CE Automatic Fines Transmittal Continuing Education Fines	PDF	English
LHL367	Provider Renewal and Information Change Form Application for Provider Renewal or Change of Contact Information.	PDF	English
LHL386	Provider Audit Affidavit Used only by continuing education providers	PDF	English
LHL615	Licensee Request TEXAS Qualifying Continuing Education Credit	PDF	English
LHL617	Request for Association Credit Accepted by TDI	PDF	English

Additional Continuing Education Forms
TDI Form Number	Description	File Format	Language
	CE Example Course Evaluation	PDF

Information Update Forms
TDI Form Number	Description	File Format	Language
LHL203	Registration of Assumed Name/Branch Locations/Entity Name Change Commonly known as form LDTL	PDF	English
LHL208	ISR Transfer/Cancel Employment Form	PDF	English
LHL236	Request for Letter(s) of Certification	PDF	English
LHL238	Biographical Form Entity/Change of Control	PDF	English
LHL388	Branch Office Address Change Request	PDF	English
LHL389	Licensee Name/Address Change Request Form	PDF	English
LHL 430	Medicare Plan Marketing Report	EXCEL
	NIPR Electronic Address Change Request for Agents and Adjusters - fill in and send on-line. (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

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Last updated: 06/09/2009

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