Form Fint02 - Escrow Officer Renewal Application Page 2
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2FINT02 | 0316
5. For verification of HOME address, complete the following information:
Street
City
State_________________ Zip Code ____________________
Area Code/Phone No. _______________________
Contact Email Address (required) _________________________________
Do you give TDI affirmative consent to release the email
address listed directly above with any other parties listed
on this application?
Yes
No
ESCROW OFFICER CERTIFICATION
I certify that I personally answered each question and that the answers are true and correct. I understand this application is for renewal
of the license type listed herein. I further certify that all information contained in my original application for license and any
subsequent renewal application including this renewal application is true and correct. (If not, please give details on a separate page.)
Signature of Escrow Officer
Typed or Printed Name of Escrow Officer
TITLE AGENT OR DIRECT OPERATION CERTIFICATION
I certify the following:
1.
I am the authorized representative of the licensed title insurance agent or direct operation,
2.
The escrow officer named above is currently a bona fide employee of the licensed title insurance agent or direct operation
that I represent, or is a bona fide employee of an attorney licensed to act as an escrow officer on behalf of the licensed title
insurance agent or direct operation that I represent,
3.
I have reviewed this application and do not have any knowledge that the information provided in this application is incorrect,
4.
I have verified that the escrow officer named above has completed all continuing education requirements.
Original Signature of Active Officer/Owner/Partner/Managing Member/On Site Manager
Date
Typed or Printed Name
Title/Position
Contact E-mail address (required)
Do you give TDI affirmative consent to release the email
address listed directly above with any other parties listed
on this application?
Yes
No
Important notice for ALL licensees: Failure to comply with any one of these requirements may result in non-renewal of your license.
All required items must be submitted simultaneously. A late fee of $17.50 per renewal is charged in addition to the renewal fee if a
COMPLETE renewal submission is not received by the current license expiration date. The $17.50 late fee is charged if all
requirements are met within 90 days of expiration. If a license has been expired for over 90 days, the license may not be renewed and
any renewal fees will not be refunded or applied towards a new application.
Note to title agent/direct operation: If this escrow officer has had a name change or does not wish to renew the license, you must
submit an endorsement or rider, to be attached to your escrow officer’s schedule bond changing or deleting the name as applicable.
NOTICE ABOUT CERTAIN INFORMATION LAWS AND PRACTICES
With few exceptions, you are entitled to be informed about the information that the Texas Department of Insurance (TDI) collects about you.
Under sections 552.021 and 552.023 of the Texas Government Code, you have a right to review or receive copies of information about yourself,
including private information. However, TDI may withhold information for reasons other than to protect your right to privacy. Under section
559.004 of the Texas Government Code, you are entitled 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 or about the procedure for correcting information kept by
TDI, please contact the Agency Counsel Section of TDI’s General Counsel Division at (512) 676-6551 or visit the Corrections Procedure section of
TDI’s website at
Return Renewal to:
Regular Mailing and Overnight Address
Texas Department of Insurance
Title Licensing Program, MC 107-TL
333 Guadalupe Street
Austin, Texas 78701
Refer questions to:
512-676-6475
Texas Department of Insurance |
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