Form 25-116 "Texas Certified Capital Company Affidavit of Individuals" - Texas

What Is Form 25-116?

This is a legal form that was released by the Texas Comptroller of Public Accounts - 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 January 1, 2005;
  • The latest edition provided by the Texas Comptroller of Public Accounts;
  • 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 25-116 by clicking the link below or browse more documents and templates provided by the Texas Comptroller of Public Accounts.

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Download Form 25-116 "Texas Certified Capital Company Affidavit of Individuals" - Texas

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25-116
(1-05)
TEXAS CERTIFIED CAPITAL COMPANY
AFFIDAVIT OF INDIVIDUALS
Name of Proposed Certified Capital Company (“CAPCO”)
State of ___________________________
County of _________________________
I, ___________________________________________ , being duly sworn, depose and say that I am the
Print Name of Affiant
____________________________________________ of the _________________________________________
Officer, Director, Partner, Trustee, Member, Manager, Principal, or Shareholder
Name of CAPCO
and hereby certify that I have received and have read Chapter 4, Subchapter B, Articles 4.51 – 4.73 of the
Texas Insurance Code, rule 34 TAC §3.833 of the Texas Administrative Code, and the Application for Certification as
a Certified Capital Company; and that I fully understand the requirements of the Statute, Regulation and Application and
agree to the provisions and conditions contained therein.
I further certify that I have not been convicted of, and am not currently under indictment or prosecution for, securities
fraud or other criminal acts; and that I have not filed for personal bankruptcy within the past ten (10) years.
____________________________________________
Signature of Affiant
Subscribed and sworn to before me this _____ day of _______________ , 20 _____ .
____________________________________________
(Notary Seal)
Signature of Notary Public
My commission expires __________________________ .
25-116
(1-05)
TEXAS CERTIFIED CAPITAL COMPANY
AFFIDAVIT OF INDIVIDUALS
Name of Proposed Certified Capital Company (“CAPCO”)
State of ___________________________
County of _________________________
I, ___________________________________________ , being duly sworn, depose and say that I am the
Print Name of Affiant
____________________________________________ of the _________________________________________
Officer, Director, Partner, Trustee, Member, Manager, Principal, or Shareholder
Name of CAPCO
and hereby certify that I have received and have read Chapter 4, Subchapter B, Articles 4.51 – 4.73 of the
Texas Insurance Code, rule 34 TAC §3.833 of the Texas Administrative Code, and the Application for Certification as
a Certified Capital Company; and that I fully understand the requirements of the Statute, Regulation and Application and
agree to the provisions and conditions contained therein.
I further certify that I have not been convicted of, and am not currently under indictment or prosecution for, securities
fraud or other criminal acts; and that I have not filed for personal bankruptcy within the past ten (10) years.
____________________________________________
Signature of Affiant
Subscribed and sworn to before me this _____ day of _______________ , 20 _____ .
____________________________________________
(Notary Seal)
Signature of Notary Public
My commission expires __________________________ .