Form VTR-436 "Owner Retained Report" - Texas

What Is Form VTR-436?

This is a legal form that was released by the Texas Department of Motor Vehicles - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2021;
  • The latest edition provided by the Texas Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form VTR-436 by clicking the link below or browse more documents and templates provided by the Texas Department of Motor Vehicles.

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Download Form VTR-436 "Owner Retained Report" - Texas

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Owner Retained Report
Vehicle Information
Vehicle Identification Number
Year
Make
Body Style
Model
Title/Document Number (leave blank if unknown)
License Plate State and Number (if any)
Insurance Company Information
Insurance Company Name
Address
City
State
Zip
Authorized Agent First Name
Middle Name
Last Name
Suffix (if any)
Email (optional)
Phone Number (optional)
Claim Information
Insured or Claimant’s First Name (or Entity Name)
Middle Name
Last Name
Suffix (if any)
Address
City
State
Zip
Date of Claim Payment
Insurance Claim Number
Damage Disclosure
Type of Damage (Check all that apply):
☐ Wrecked
☐ Burned
☐ Flood Damage
☐ Strip
ped of Major Component Parts
The motor vehicle described above meets the following definition as defined in Texas Transportation Code, Section 501.091: (Check One)
☐ Salvage Vehicle
☐ Nonrepairable Vehicle
Please identify whether any damaged major component p art(s) can be repaired or must be replaced:
Major Component Part
Repair Replace Major Component Part
Repair Replace
Engine
Front Bumper
Transmission
Rear Bumper
Frame
Rear Driver Side Quarter Panel
Front Driver Side Fender
Rear Passenger Side Quarter Panel
Front Passenger Side Fender
Deck (Trunk) Lid
Hood
Tailgate
Driver Side Door
Hatchback
Driver Side Passenger Door
Truck Cab
Front Passenger Door
Body of Passenger Vehicle
Rear Passenger Door
Roof of Passenger Vehicle (if separate from the body)
Cargo Box (gross vehicle weight of 10,000 lbs. or less,
Floor Pan of Passenger Vehicle (if separate from the
including a truck)
body)
Certification – State law makes falsifying information a third degree felony
I, the authorized agent of the insurance company listed above, certify the insurance company paid a claim for the motor vehicle described
above, the owner has retained the motor vehicle, and the motor vehicle meets the definition of a salvage or nonrepairable vehicle as
indicated above. Further, I certify, the owner of the motor vehicle has been notified of this report and the requirements for operation or
transfer of ownership of the motor vehicle.
Signature of Authorized Agent
Printed Name (Same as Signature)
Date
VTR-436 Rev 06/21
Form available online at www.TxDMV.gov
Page 1 of 2
Owner Retained Report
Vehicle Information
Vehicle Identification Number
Year
Make
Body Style
Model
Title/Document Number (leave blank if unknown)
License Plate State and Number (if any)
Insurance Company Information
Insurance Company Name
Address
City
State
Zip
Authorized Agent First Name
Middle Name
Last Name
Suffix (if any)
Email (optional)
Phone Number (optional)
Claim Information
Insured or Claimant’s First Name (or Entity Name)
Middle Name
Last Name
Suffix (if any)
Address
City
State
Zip
Date of Claim Payment
Insurance Claim Number
Damage Disclosure
Type of Damage (Check all that apply):
☐ Wrecked
☐ Burned
☐ Flood Damage
☐ Strip
ped of Major Component Parts
The motor vehicle described above meets the following definition as defined in Texas Transportation Code, Section 501.091: (Check One)
☐ Salvage Vehicle
☐ Nonrepairable Vehicle
Please identify whether any damaged major component p art(s) can be repaired or must be replaced:
Major Component Part
Repair Replace Major Component Part
Repair Replace
Engine
Front Bumper
Transmission
Rear Bumper
Frame
Rear Driver Side Quarter Panel
Front Driver Side Fender
Rear Passenger Side Quarter Panel
Front Passenger Side Fender
Deck (Trunk) Lid
Hood
Tailgate
Driver Side Door
Hatchback
Driver Side Passenger Door
Truck Cab
Front Passenger Door
Body of Passenger Vehicle
Rear Passenger Door
Roof of Passenger Vehicle (if separate from the body)
Cargo Box (gross vehicle weight of 10,000 lbs. or less,
Floor Pan of Passenger Vehicle (if separate from the
including a truck)
body)
Certification – State law makes falsifying information a third degree felony
I, the authorized agent of the insurance company listed above, certify the insurance company paid a claim for the motor vehicle described
above, the owner has retained the motor vehicle, and the motor vehicle meets the definition of a salvage or nonrepairable vehicle as
indicated above. Further, I certify, the owner of the motor vehicle has been notified of this report and the requirements for operation or
transfer of ownership of the motor vehicle.
Signature of Authorized Agent
Printed Name (Same as Signature)
Date
VTR-436 Rev 06/21
Form available online at www.TxDMV.gov
Page 1 of 2
Owner Retained Report
Information
This form is required to be submitted by an insurance company paying a claim on a vehicle deemed salvage or nonrepairable that is
retained by the owner. This report must be filed within 30 days if the insurance company does not acquire ownership of the vehicle. The
insurance c ompany must provide notice of this report to the vehicle owner and advise the owner of the conditions regarding the vehicle
operation. Do not submit this form if the motor vehicle is not damaged to the extent that it meets the definition of a salvage or
nonrepairable v ehicle.
This report may be submitted electronically through
webSALVAGE
for insurance companies that create or have an account. Otherwise, this
completed form must be submitted to the department at one of the following:
Email: TCS_Mailbox@txdmv.gov
Fax:
(512) 465-4124
Mail:
Texas Department of Motor Vehicles
Vehicle Titles and Registration Division
ATTN: Title C ontrol S ystems
Austin, Texas 78779-0001
Definitions
A salvage m otor vehicle:
has damage to or is missing a major component part to the extent that the cost of repairs exceeds the actual cash value of the
motor vehicle immediately before the damage. Cost of repair calculations may include parts and labor, but must exclude the cost of
materials and labor for repainting the motor vehicle and sales tax on the total cost of repairs, or
comes into this state under an out of state salvage motor vehicle title or similar out of state ownership document.
A salvage m otor vehicle is not:
an out of state motor vehicle with a “rebuilt,” “prior salvage,” or similar notation, or
a nonrepairable motor vehicle, or
a motor vehicle which an insurance company has paid a claim for the cost of repairing hail damage or theft unless the motor vehicle
was damaged during the theft to the extent that the cost of repair exceeds the actual cash value immediately before the damage.
A salvage motor vehicle may not be registered or operated on a public highway until the vehicle has passed a Texas vehicle safety
inspection and a certificate of title branded “Rebuilt Salvage” has been issued.
A nonrepairable motor vehicle:
is damaged, wrecked, or burned to the extent that the only residual value of the vehicle is as a source of parts or scrap metal; or
comes into this state under a title or other ownership document that indicates the vehicle is nonrepairable, junked, for parts or
dismantling only, or a similar notation.
A nonrepairable motor vehicle may not be repaired, rebuilt, reconstructed, or made operable for use on a public highway.
Owner Notification Requirements
Insurance companies must send a notice to owners who retain a salvage or nonrepairable vehicle following payment of a claim. The notice
to the owner must include the following information:
• The vehicle was reported to the Texas Department of Motor Vehicles as an owner retained salvage or nonrepairable vehicle, as
applicable.
• The owner is required to a pply for the appropriate salvage or nonrepairable title prior to selling or otherwise transferring ownership
of the motor vehicle.
• The type of title the owner must obtain (Salvage Vehicle Title or Nonrepairable Vehicle Title).
• The registration to the motor vehicle is no longer valid, and the owner may not operate or permit operation of the motor vehicle o n
the public roads.
• If the v ehicle is nonrepairable, the vehicle:
o may never be registered, operated, or permitted to operate on public roads;
o may only be used as a source for used parts or scrap metal;
o may not be repaired, rebuilt, or reconstructed; and
o may only be issued a Nonrepairable Vehicle Title.
• If the v ehicle is salvage, the owner:
o must apply to the Texas Department of Motor Vehicles for a Salvage Vehicle Title prior to repairing/rebuilding the vehicle;
o must obtain a passing vehicle safety inspection after the vehicle has been repaired or rebuilt;
o may not operate the motor vehicle on the p ublic roads until it has been repaired/rebuilt and retitled as a rebuilt salvage motor
vehicle and properly registered; and
o will be required to pay a $65 Rebuilt Fee, $28 or $33 title application fee, and any applicable registration fees (if registering) at
the time of application for a rebuilt salvage Texas title.
VTR-436 Rev 06/21
Form available online at www.TxDMV.gov
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