These forms are available for download in Adobe Acrobat .pdf format. Acrobat Reader is necessary to view .pdf files. If you need to obtain a copy of this program it is available as a free download for Windows or Macintosh operating systems.
Please note the following policy regarding the filing of forms which collect a person's individual information:
"An individual who completes and files this form with the Texas Department of Licensing and Regulation (the Department) is entitled to the following from the Department:
(1) to be informed about the information that the Department collects about the individual, upon the request of the individual and subject to a few exceptions;
(2) to receive and review the information, under Sections 552.021 and 552.023 of the Texas Government Code; and
(3) to have the Department correct information about the individual that is incorrect, under Section 559.004 of the Texas Government Code."
Each Service Contract Provider who intends to use a reimbursement insurance policy to meet their financial security requirement must obtain a Texas endorsement. The endorsement must be filed with the Texas Department of Insurance (TDI) for approval. Once the endorsement has been approved, a copy of the approval letter from TDI must be submitted to the department before issuance of the license. The Texas endorsement is required for each policy.
TDLR Complaint Sign (pdf)
Form AP-152, Texas Application for Payee Identification Number (pdf, will open in a new window)