Form Fint130 - Application For Direct Operation License Form - Texas Department Of Insurance

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FINT130 | 0316
APPLICATION FOR DIRECT OPERATION LICENSE
Beginning July 3 2014, all title agencies must comply with the
minimum capitalization requirements in Administrative Rule
1. _______________________________________________
S-1. Submit the latest copy of the title agency’s form TS-1,
Title Agency Name
TS-2, or other evidence showing how the title agency meets
the minimum capitalization requirements.
________________________________________
FEIN Number:
2. Business Address (main office): [NOTE: If license is approved, this address must be kept current at all times.]
Street: _____________________________________________________________________________________
(This must be a Texas physical address)
City: __________________________________ State: _____________________________
Zip: ____________
Mailing Address: _________________________________________________________________________________
(This must be a Texas mailing address)
City: __________________________________ State: _____________________________
Zip: ____________
3. List county or counties that the entity will be licensed in; and the physical office address for each (if applicable).
(Attach a separate sheet, if necessary)
County
Physical Office Location
_______________________________ ______________________________________________________________
_______________________________ ______________________________________________________________
_______________________________ ______________________________________________________________
_______________________________ ______________________________________________________________
_______________________________ ______________________________________________________________
4. Attach an Abstract Plant Information, FINT120 form, for each county named.
5. Fiscal year-end date selected for Article 9.39 annual escrow audit purposes: ___________________________
6. Is the proposed Direct Operation a Texas Corporation?
Yes
No
7. If a foreign corporation, has it been authorized to do business in Texas?
Yes
No
8. Do you certify that the proposed direct operation is qualified as a direct operation
as defined in the “Texas Title Insurance Act”?
Yes
No
9. Texas Department of Insurance Company No. ______________________
10. Dated _____________________
11. ______________________________________________
12. _______________________________________
Name of Title Insurance Company
Original Signature of Person Authorized to
Sign for Title Insurance Company
13. ______________________________________________
14. _______________________________________
Mailing Address
Title
15. ______________________ ___________
____________ 16. _______________________________________
City
State
Zip Code
Address of Person Authorized to Sign for
Title Insurance Company
Subscribed and sworn to before me
(Affix Notary Seal Here)
Date ____________________
Notary Public _____________________________________
Texas Department of Insurance |
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