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

This version of the form is not currently in use and is provided for reference only.
Download this version of Form FIN533 for the current year.

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 October 1, 2019;
  • 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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FIN533 | 1019
Clear form
Agent / adjuster name or address change request form
You must fill out and send us this document within 30 days of a change to your name or address.
���� An agent / adjuster moving to Texas will need to 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 PO Box __________________________________________________________________________
City
State
ZIP
____________________________________________________________
___________________
______________________
���� A PO Box will be accepted only for a mailing address.
Texas Department of Insurance
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FIN533 | 1019
Clear form
Agent / adjuster name or address change request form
You must fill out and send us this document within 30 days of a change to your name or address.
���� An agent / adjuster moving to Texas will need to 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 PO Box __________________________________________________________________________
City
State
ZIP
____________________________________________________________
___________________
______________________
���� A PO Box will be accepted only for a mailing address.
Texas Department of Insurance
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| 1019
FIN533
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 have the right to see and get facts we have about you: You must ask us in writing. You might need
to pay to get a copy of this information. You can send your letter or email one of these ways:
Email:
OpenRecords@tdi.texas.gov
Mail:
Texas Department of Insurance
Public Information Coordinator PO
Fax: 512-490-1021
Box 149104 (Mail code 112-1C)
In person: 333 Guadalupe, Austin, Texas 78701
Austin, Texas 78714-9104
You have the right to ask that we fix information we have about you that is wrong: You must ask us in
writing. The letter or email must have: (1) your name and mailing address, (2) your phone number,
(3) details about what needs to be fixed, and (4) the reason or proof showing why the information is wrong.
You can send your letter or email one of these ways:
Email:
RecordCorrections@tdi.texas.gov]
Mail:
Texas Department of Insurance
Fax: 512-490-1025
Record Correction Request
In person: 333 Guadalupe, Austin, Texas 78701
PO Box 149104 (Mail code 113-1C)
Austin, Texas 78714-9104
Submit
Texas Department of Insurance
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