Form FIN533 "Agent/Adjuster Name or Address Change Request Form" - Texas

What Is Form FIN533?

This is a legal form that was released by the Texas Department of Insurance - 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 November 1, 2020;
  • The latest edition provided by the Texas Department of Insurance;
  • 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 FIN533 by clicking the link below or browse more documents and templates provided by the Texas Department of Insurance.

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Download Form FIN533 "Agent/Adjuster Name or Address Change Request Form" - Texas

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| 1120
FIN533
Clear
Clear form
Clear form
Agent/adjuster name or address change request form
You must fill out and send us this form within 30 days of a change to your name or address.
Notes: If you’ve moved from Texas to another state, contact the department of insurance in your new
state before submitting this form. You must have a license in your new state of residence before we
can change your Texas license to a nonresident license.
If you’re a licensed agent or adjuster in another state who has moved to Texas, you must fill out form
FIN594.
TDI license number
Name as listed on your license
First name
Middle name
Last name
Suffix
Fill out this section if you changed your name:
New legal name
First name
Middle name
Last name
Suffix
���� Attach a copy of an official document showing that your name changed. For example, send a
copy of a marriage certificate or divorce decree.
Fill out all parts of this section if your address changed:
Phone numbers
Personal
Business
(
)
_
(
)
Email addresses
Personal
Business
Business address
Street address
City
State
ZIP
_
Mailing address
Street address or P.O. Box
1/2
Texas Department of Insurance
| 1120
FIN533
Clear
Clear form
Clear form
Agent/adjuster name or address change request form
You must fill out and send us this form within 30 days of a change to your name or address.
Notes: If you’ve moved from Texas to another state, contact the department of insurance in your new
state before submitting this form. You must have a license in your new state of residence before we
can change your Texas license to a nonresident license.
If you’re a licensed agent or adjuster in another state who has moved to Texas, you must fill out form
FIN594.
TDI license number
Name as listed on your license
First name
Middle name
Last name
Suffix
Fill out this section if you changed your name:
New legal name
First name
Middle name
Last name
Suffix
���� Attach a copy of an official document showing that your name changed. For example, send a
copy of a marriage certificate or divorce decree.
Fill out all parts of this section if your address changed:
Phone numbers
Personal
Business
(
)
_
(
)
Email addresses
Personal
Business
Business address
Street address
City
State
ZIP
_
Mailing address
Street address or P.O. Box
1/2
Texas Department of Insurance
| 1120
FIN533
City
State
ZIP
_
���� A P.O. Box will be accepted only for a mailing address.
Resident address
Street address
City
State
ZIP
_
���� Attach a copy of a Letter of Certification from your resident state.
Sign here:
The answers I gave on this form are true and correct:
Licensee signature
Date
Print name
Contact us if you have questions:
You can: (1) email License@tdi.texas.gov, or (2) call 512-676-6500.
Know your rights:
You can request information we have about you by emailing
OpenRecords@tdi.texas.gov
or writing
to: Public Information Coordinator, Texas Department of Insurance, PO Box 149104 (mail code 112-
1C) Austin, Texas 78714-9104. You also have the right to ask that we fix information we have about
you that is wrong. To ask for a correction, send (1) your name, mailing address, and your phone
number, (2) details about what needs to be fixed, and (3) the reason or proof showing why the
information is wrong. Send this by email to
RecordCorrections@tdi.texas.gov
or by mail to: Record
Correction Request, Texas Department of Insurance, PO Box 149104 (mail code 113-1C), Austin,
Texas 78714-9104.
Submit
Submit
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Texas Department of Insurance
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