Form Aqi-1, Application For Appointment Page 2

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PC425 (Form AQI-1) | 1116
Section D: Other Education or Training
Subject Matter
Dates Attended
Section E:
Experience in the design of structures to meet windstorm resistant building requirements.
Have you designed structures and calculated wind loads for structures located in high wind areas?
What percentage of your work has been for the design of structures in high wind areas?
How long have you been designing structures in high wind areas?
Number of years
Section F:
Signature (in ink)
Under Insurance Code § 2210.256, if the commissioner finds that an appointed qualified inspector knowingly, willfully, fraudulently, or with gross
negligence signed or caused to be prepared an inspection report that contains a false or fraudulent statement, the commissioner may, after notice
and hearing, issue an order directing the appointee to pay a fine not to exceed $5,000. Under Insurance Code art. 21.47, a person commits a felony
offense if the person knowingly or intentionally makes, files or uses any instrument in writing required to be made to or filed with the commissioner,
either by the Insurance Code or by rule, when the instrument in writing contains any false, fictitious, or fraudulent statement or entry with regard to
any material fact.
Return application to:
Texas Department of Insurance
Engineering Services Program
Mail Code 104-ENG
P. O. Box 149104
Austin, Texas 78714-9104
For further information or questions, contact (800) 248-6032, option 5,, or Fax (512) 490-1043.
Access and Correction of Personal Information
With few exceptions, you are entitled to be informed about the information that TDI collects about you. Under Government Code
§ 552.021 and § 552.023, you have a right to review or receive copies of information about yourself, including private inform ation.
However, TDI may withhold information for reasons other than to protect your right to privacy. Government Code § 559.004 enti tles
you to request that TDI correct information that TDI has about you that is incorrect. For more information about the procedure and
costs for obtaining information from TDI please visit For information about the
procedure for correcting information kept by TDI, please visit You may also
send a request for information to
Texas Department of Insurance |


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