REQUEST FOR LETTER(S) OF CERTIFICATION FOR AGENTS ...
FIN530 | 0119
REQUEST FOR LETTER(S) OF CERTIFICATION FOR AGENTS, ADJUSTERS, & ENTITIES
Third Party Administrators and Premium Finance? Do not use this form.
Each letter of certification requires a filing fee of $11.00, made payable to the Texas Department of Insurance.
Please return this form with your payment to:
Texas Department of Insurance, MC 107-1A
Certifications may be ordered online from
Agent and Adjuster Licensing
Only Visa and MasterCard are accepted.
P.O. Box 12069
There is a small convenience fee.
Austin, TX 78711-2069
The following information is required to ensure that you receive the information being requested. Please complete with no more than ten individuals or entity names per document.
INDIVIDUAL / ENTITY
SOCIAL SECURITY/ FEIN NO.
QUANTITY___________
1. _________________________________________________________________________________________________________________________
2. _________________________________________________________________________________________________________________________
3. _________________________________________________________________________________________________________________________
4. _________________________________________________________________________________________________________________________
5. _________________________________________________________________________________________________________________________
6. _________________________________________________________________________________________________________________________
7. _________________________________________________________________________________________________________________________
8. _________________________________________________________________________________________________________________________
9. _________________________________________________________________________________________________________________________
10. _________________________________________________________________________________________________________________________ LETTER(S) REQUESTED ___________ X $11.00 = FEE TOTAL $___________________
CONTACT PERSON: ______________________________________________________________________________________________________________________ EMAIL ADDRESS: _______________________________________________________ TELEPHONE NO: ____________________________________________ COMPANY NAME: _______________________________________________________________________________________________________________________ RETURN ADDRESS: _______________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________
Texas Department of Insurance | tdi.
1/1
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- national producer number npn validation
- florida department of financial services division of
- citizens protection classes wind zones bcegs
- sellers of travel registration application
- state of florida department of highway safety and
- procedures manual for implementation of the
- request for letter s of certification for agents
- emergency financial preparedness toolkit
Related searches
- request for hearing department of educat
- request for hearing department of education
- publishing agents for children s books
- literary agents for children s books
- request for payment letter template
- request for medical records letter example
- sample letter request for meeting
- request for payment letter sample
- request for information letter examples
- request for letter of recommendation
- letter s worksheets for kids
- letter s worksheet for kids