"Trust-Funded Repaid Funeral Benefits Contract Application Required Exhibits Checklist" - Texas

Trust-Funded Repaid Funeral Benefits Contract Application Required Exhibits Checklist is a legal document that was released by the Texas Department of Banking - a government authority operating within Texas.

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TRUST-FUNDED PREPAID FUNERAL BENEFITS CONTRACT APPLICATION
REQUIRED EXHIBITS CHECKLIST
☐ Check or money order in the amount of $500.00 made payable to: TEXAS DEPARTMENT OF BANKING. Please
follow directions on the enclosed invoice.
☐ Completed questionnaire on pages 1 – 4 of the application. Page 4 of the application is to be signed by an officer of
the applicant and notarized.
☐ Exhibit “A” – Biographical data for each principal owner, partner, or officer with at least a 25% controlling interest
of the business. If this is not applicable, please provide an explanation of the ownership structure, an organizational
chart, a list of investors, and biographical data for each officer. Additionally, refer to Supervisory Memorandum 1042
regarding the effects of criminal convictions on licensing.
☐ Exhibit “B” – Printer’s proof of the contract with the Seller’s information pre-printed. Additionally, Section 25.9(c)
of the Texas Administrative Code requires a package disclosure to be either on the contract form, on the price list, or
provided as an addendum. If the disclosure is not included on your contract form, please provide a copy of the price
list or addendum that contains the disclosure.
☐ Exhibit “C” – Trust Agreement, if the funds are to be deposited in a formal trust account. A sample trust agreement
is available on the Department’s website if you choose this type of deposit account. (Not applicable to business
custodial accounts i.e. savings or CDs.)
☐ Exhibit “D” – Written investment plan, if the funds are to be deposited in a formal trust account. See Section 154.258
of the Texas Finance Code and Sections 25.51-25.59 of the Texas Administrative Code for investment limitations.
☐ Exhibit “E” – Financial statements, including a balance sheet and income statement, dated as of the last day of the
applicant’s fiscal year that ended in the immediately preceding calendar year that reflect the financial condition of the
applicant. In addition, if deemed necessary, the Department reserves the right to request additional financial
information to determine if the applicant has the financial capacity to obtain a permit.
☐ Exhibit “F” – Proof of Good Standing with the Texas Comptroller of Public Accounts, if applicable.
☐ Exhibit “G” – If applicable, an assumed name certificate that has been filed and executed by the County Clerk and/or
Secretary of State. Please refer to the Assumed Name Certificate instructions enclosed for more information.
☐ Exhibit “H” – Copy of the corporate charter and articles of incorporation, if applicable.
☐ Exhibit “I” – Completed agent designation forms (both pages) for each agent. At least one agent must be designated
who is responsible for the receipt and remittance of monies collected to the depository, accepting payments, and/or
handling funds collected under the prepaid funeral program either at the office of the seller or off premises.
☐ Exhibit “J” – Authorization for Direct Payment (ACH Debit) form, required per Section 25.23 and 25.24 of the
Texas Administrative Code.
☐ Proof of Ownership of the funeral home or business entity.
TRUST-FUNDED PREPAID FUNERAL BENEFITS CONTRACT APPLICATION
REQUIRED EXHIBITS CHECKLIST
☐ Check or money order in the amount of $500.00 made payable to: TEXAS DEPARTMENT OF BANKING. Please
follow directions on the enclosed invoice.
☐ Completed questionnaire on pages 1 – 4 of the application. Page 4 of the application is to be signed by an officer of
the applicant and notarized.
☐ Exhibit “A” – Biographical data for each principal owner, partner, or officer with at least a 25% controlling interest
of the business. If this is not applicable, please provide an explanation of the ownership structure, an organizational
chart, a list of investors, and biographical data for each officer. Additionally, refer to Supervisory Memorandum 1042
regarding the effects of criminal convictions on licensing.
☐ Exhibit “B” – Printer’s proof of the contract with the Seller’s information pre-printed. Additionally, Section 25.9(c)
of the Texas Administrative Code requires a package disclosure to be either on the contract form, on the price list, or
provided as an addendum. If the disclosure is not included on your contract form, please provide a copy of the price
list or addendum that contains the disclosure.
☐ Exhibit “C” – Trust Agreement, if the funds are to be deposited in a formal trust account. A sample trust agreement
is available on the Department’s website if you choose this type of deposit account. (Not applicable to business
custodial accounts i.e. savings or CDs.)
☐ Exhibit “D” – Written investment plan, if the funds are to be deposited in a formal trust account. See Section 154.258
of the Texas Finance Code and Sections 25.51-25.59 of the Texas Administrative Code for investment limitations.
☐ Exhibit “E” – Financial statements, including a balance sheet and income statement, dated as of the last day of the
applicant’s fiscal year that ended in the immediately preceding calendar year that reflect the financial condition of the
applicant. In addition, if deemed necessary, the Department reserves the right to request additional financial
information to determine if the applicant has the financial capacity to obtain a permit.
☐ Exhibit “F” – Proof of Good Standing with the Texas Comptroller of Public Accounts, if applicable.
☐ Exhibit “G” – If applicable, an assumed name certificate that has been filed and executed by the County Clerk and/or
Secretary of State. Please refer to the Assumed Name Certificate instructions enclosed for more information.
☐ Exhibit “H” – Copy of the corporate charter and articles of incorporation, if applicable.
☐ Exhibit “I” – Completed agent designation forms (both pages) for each agent. At least one agent must be designated
who is responsible for the receipt and remittance of monies collected to the depository, accepting payments, and/or
handling funds collected under the prepaid funeral program either at the office of the seller or off premises.
☐ Exhibit “J” – Authorization for Direct Payment (ACH Debit) form, required per Section 25.23 and 25.24 of the
Texas Administrative Code.
☐ Proof of Ownership of the funeral home or business entity.
INACCURATE OR INCOMPLETE DATA WILL RESULT IN A DELAY IN PROCESSING THE PERMIT
APPLICATION. IF THE APPLICATION IS NOT COMPLETED WITHIN 60 DAYS OF THE INITIAL FILING,
THE APPLICATION MAY BE CLOSED AND THE FILING FEE SURRENDERED.
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