Form FIN498 "Third-Party Administrators Notice of Change of Address and/or Contact" - Texas

What Is Form FIN498?

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, 2016;
  • 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 FIN498 by clicking the link below or browse more documents and templates provided by the Texas Department of Insurance.

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Download Form FIN498 "Third-Party Administrators Notice of Change of Address and/or Contact" - Texas

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FIN498 | 1116
Third-Party Administrators Notice of Change of Address and/or Contact
To notify the Texas Department of Insurance of a change of address in the mailing or physical address of a
Third-Party Administrator licensed in accordance with Texas Ins. Code, Chap. 4151, please complete the
following:
TDI COMPANY NUMBER
EFFECTIVE DATE OF CHANGE
TPA NAME
NEW MAILING ADDRESS
CITY, STATE, ZIP (for mailing address)
NEW PHYSICAL ADDRESS
(Note: TPAs domiciled in Texas must maintain a physical address in Texas)
CITY, ST, ZIP (for physical address)
NEW CONTACT PERSON (should be located at the mailing address)
________________________________
TELEPHONE NUMBER
TOLL FREE NUMBER
FAX NUMBER
WEBSITE
EMAIL
By:
(signature)
(typed or printed name)
(title)
Texas Department of Insurance | www.tdi.texas.gov
1/1
FIN498 | 1116
Third-Party Administrators Notice of Change of Address and/or Contact
To notify the Texas Department of Insurance of a change of address in the mailing or physical address of a
Third-Party Administrator licensed in accordance with Texas Ins. Code, Chap. 4151, please complete the
following:
TDI COMPANY NUMBER
EFFECTIVE DATE OF CHANGE
TPA NAME
NEW MAILING ADDRESS
CITY, STATE, ZIP (for mailing address)
NEW PHYSICAL ADDRESS
(Note: TPAs domiciled in Texas must maintain a physical address in Texas)
CITY, ST, ZIP (for physical address)
NEW CONTACT PERSON (should be located at the mailing address)
________________________________
TELEPHONE NUMBER
TOLL FREE NUMBER
FAX NUMBER
WEBSITE
EMAIL
By:
(signature)
(typed or printed name)
(title)
Texas Department of Insurance | www.tdi.texas.gov
1/1