Form Fin518 - Course Assignment Form - Texas Department Of Insurance Page 2
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2FIN518 | 0115
Instructions
In order for a provider to assign a course to another, that provider must have ownership rights to the course being
assigned. This assignment form must be completed by the assignee and signed by the provider representatives for
both the assignee and the assignor. The form must either be typewritten or completed in ink. The completed form
must be sent to the Texas Department of Insurance, Licensing Division (MC 107- 1A), P. O. Box 12200 Austin, TX 78711-
2200, along with a check or money order for the non-refundable course assignment fee of $50 per course assigned.
Before completing this form, you need to be familiar with 28 TAC §§19.1008(f) and 19.1012(b)(3). You may access a
copy of the Texas Administrative Code, Continuing Education Rule online through the Department’s web site.
Part A: General Information
1) Complete the blanks by inserting the assignee’s current provider registration number and registered name. The
assignee is a registered provider to whom the right to present this course is assigned.
2) The assignee must indicate a yes or no response to each question by checking only one box per question. If a
“Yes” response has been checked, the course must be submitted as a new course.
3) Complete the blanks by inserting the assignor’s current provider registration number and registered name. The
assignor is the registered provider who obtained certification from the department for the original course and is
responsible for the re-certification of the course.
4) Using a format of MM/DD/YYYY, insert the actual calendar date that the assignment is to take effect. Use a date
at least 10 days after form is mailed to this department.
5) Using a format of MM/DD/YYYY, insert the actual calendar date that the assignment period terminates. There
must be a termination date stated, and it may be no more than two years from the assignment date. It may be
less. Assignment termination occurs if assignor allows course to expire. Assignee may be penalized if assigned
course is offered after original course has expired and before assignor recertifies it. Nothing on this form
precludes the parties from submitting a new assignment before this one terminates or mutually agreeing in
writing to an early termination. The department will not be party to any disputes between the assignee and
assignor. The department will not terminate an assignment prior to the termination date on this form except as
provided for under 28 TAC §19.1008(f) (8).
6) Provide information on the course being assigned.
a. Complete the blank by inserting the name of the course as originally filed by the assignor and certified by
the department.
b. Insert the original course certification number as provided by the department on the approval letter sent to
the assignor.
c. Using a format of MM/DD/YYYY, insert the expiration date of the original course certification. Note:
Assignment of this course does not work to extend the course expiration date.
Part B: Certification
Both parties certify the correctness of the information they placed on the form.
Texas Department of Insurance |
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