Form Aqi-1, Application For Appointment Page 2

Download a blank fillable Form Aqi-1, Application For Appointment in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Aqi-1, Application For Appointment with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

PC425 (Form AQI-1) | 1116

Section D: Other Education or Training

Course

Subject Matter

Dates Attended

Section E:

Experience in the design of structures to meet windstorm resistant building requirements.

Yes

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

months

Section F:

Signature (in ink)

Date

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, engineering@tdi.texas.gov, 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