Service Contract Providers

Forms

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.

Form #002 SCP, Service Contract Provider Registration Application (pdf)

Form #005 SCP, Sample Letter of Credit (pdf)

Form #007 SCP, Service Contract Provider Administrator Application(pdf)

Form #009 SCP, Service Contract Provider Personal Information Form (pdf)

Form #010 SCP, Identity Recovery Service Contract Quarterly Report (pdf)

Form #012 SCP, Funded Reserve and Security Deposit Financial Security Calculation Form (pdf)

Form #014 SCP, Service Contract Provider Transition Form (pdf)

Form #030 SCP, Texas Endorsement Form (pdf)

Occupational License Application Claiming to Have No Social Security Number(pdf)

Order a Duplicate License Online

Form #002 LIC, Criminal History Questionnaire (pdf)

Criminal History Evaluation Letter