Contents
Form Example
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TDI USE ONLY |
FPCARD: ﾅ |
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Texas Department of Insurance |
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CO. ID: |
LIC.#: |
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Property & Casualty Program - Title Division, Mail Code |
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PID: |
EXP: |
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333 Guadalupe ｺ P. O. Box 149104, Austin, Texas |
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ISSUE: |
RIDER: |
ﾅ |
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R.R.#: |
OTHER: |
ﾅ |
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ＤＳＳＯＬＦＤＷＬＲＱ＃ＩＲＵ＃ＷＨ［ＤＶ＃ＨＶＦＵＲＺ＃ＲＩＩＬＦＨＵﾶＶ＃ＯＬＦＨＱＶＨ＃
***ACTING AS AN ESCROW OFFICER BEFORE YOUR LICENSE IS ISSUED IS A VIOLATION OF §2652.001 AND IS SUBJECT TO DISCIPLINARY ACTION INCLUDING FINES AND LICENSE DENIAL AND/OR REVOCATION (see Title Bulletin No. 164)***
INSTRUCTIONS
1.Applicant (and employer attorney if applicable) must complete Section A.
2.Sponsoring title agent/direct operation must complete Section B.
3.Licensing fee of $35.00 must be submitted.
4.Texas escrow officer's schedule bond must be attached, if needed. (If bond is already on file, rider or endorsement must be attached).
5.Fingerprints and criminal history information ﾱ＃see addendum regarding requirements
SECTION A |
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Mr. |
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1. |
Name in full: Mrs. Last |
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First |
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Middle |
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Ms. |
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(No initials accepted) |
(No initials accepted) |
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2. |
Residence Address |
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City |
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State |
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Zip |
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Phone No. ( |
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3. |
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(required for notification purposes) |
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4. Social Security Number |
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5. Texas Resident |
(Disclosure of Social Security Number is required by the Texas Family Code §231.302)
6. |
Date of Birth |
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7. Driver's License # |
State |
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(MM |
DD YYYY) |
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8. |
Marital Status |
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Single |
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Married |
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Divorced |
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Widowed |
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ﾅYes
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No
－Ｌｉ＃｜ｒｘ＃ｄｑｖｚｈｕ＃ﾳ＼ｈｖﾴ＃ｗｒ＃ｔｘｈｖｗｌｒｑ＃＜ｄ／＃＜ｅ／＃＜ｆ／＃ｄｑｇ２ｒｕ＃＜ｇ／＃｜ｒｘ＃ｐｘｖｗ＃ｖｘｅｐｌｗ＃ｒｕｌｊｌｑｄｏ＃ CERTIFIED copies of the indictment or charging document, conviction, order deferring adjudication, judgment and conditions of probation from the appropriate jurisdiction, for each and every crime or offense. You may also include letters of recommendation on your behalf. Please provide full information with dates and details on a separate sheet of paper. Application processing will be suspended until the details are received and a review is completed. If certified documents have been previously submitted to
the department, please do not resend.
9.Excluding traffic violations and first offense DWI:
a. do you currently have any pending misdemeanor or felony charges (by indictment,
information, or any other instrument) filed against you in Texas, any other state, or by |
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the federal government? |
*ﾅ YES |
b. have you ever been convicted of any misdemeanor or felony offense in Texas, any other |
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state, or by the federal government? |
*ﾅ YES |
c.have you ever had adjudication deferred on any misdemeanor or felony charge or offense
in Texas, any other state, or by the federal government? |
*ﾅ YES |
d. have you ever served any period or probation for any misdemeanor or felony offense in |
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Texas, any other state, or by the federal government? |
*ﾅ YES |
ﾅNO
ﾅNO
ﾅNO
ﾅNO
PC132 Rev. 08/11 |
Page 1 of 4 |
NOＷＨ＝＃＃ＬＩ＃＼ＲＸ＃ＤＱＶＺＨＵ＃ﾳ＼ＨＶﾴ＃ＷＲ＃ＤＱ＼＃ＲＩ＃ＴＸＨＶＷＬＲＱＶ＃４３＃ＷＫＵＲＸＪＫ＃４：／＃＼ＲＸ＃ＰＸＶＷ＃ＤＷＷＤＦＫ＃Ｄ＃ＳＨＵＶＲＱＤＯ＃
STATEMENT WITH DATES AND COMPLETE DETAILS. APPLICATION PROCESSING WILL BE SUSPENDED UNTIL THE DETAILS ARE RECEIVED AND A REVIEW IS COMPLETED.
10. |
Have you ever had a professional license, an insurance license or company appointment |
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refused, suspended or revoked in Texas or any other state? |
ﾅ YES |
ﾅ NO |
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11. |
Are you now indebted to a special deputy receiver of the Texas Department of Insurance, |
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any insurance company, general agent or agent? |
ﾅ YES |
ﾅ NO |
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12. |
Have you ever had an agency contract canceled for cause (e.g., misrepresentation, |
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misappropriation, etc.)? |
ﾅ YES |
ﾅ NO |
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Have you ever been placed under injunction or restraining order of a court or regulatory |
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agency in respect to violation of any federal or state law relating to insurance or securities? |
ﾅ YES |
ﾅ NO |
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Do you now have pending litigation against you alleging violation of the Texas Insurance Code |
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or the insurance laws of any other state? |
ﾅ YES |
ﾅ NO |
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Have you ever held ownership interest in any insurance agency or company? |
ﾅ YES |
ﾅ NO |
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Do you have any judgments against you held by any insurance company or insured which |
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are unpaid in whole or in part? |
ﾅ YES |
ﾅ NO |
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Do you have any judgments against you which involved violation of the Texas Insurance Code |
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or the insurance laws of any other state? |
ﾅ YES |
ﾅ NO |
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18. |
Do you have another business name or alias? |
ﾅ YES |
ﾅ NO |
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If YES, indicate business name or alias here: |
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19. |
Have you ever held a professional license, insurance license or company appointment under |
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any other name? |
ﾅ YES |
ﾅ NO |
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If YES, indicate other name(s) here:
20. Do you currently hold an escrow officer license?
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YES
ﾅNO
If YES, and you indicate you are a bona fide employee of a title insurance agent/direct operation in question No. 21, you certify by signing this application that the existing license will be canceled within 60 days or you are a bona fide employee of separate title insurance agents/direct operations. If you are a bona fide employee of separate title insurance agents/direct operations, you may be required to provide supporting documentation (see Title Bulletin No. 162).
21.Check applicable status of employment for this application:
ﾅI am a bona fide employee of the title agent/direct operation
ﾅI am an attorney
ﾅI am a bona fide employee of an attorney who is a Texas licensed escrow officer
EMPLOYER ATTORNEY MUST COMPLETE THE FOLLOWING ONLY IF APPLICANT CHECKED THE THIRD BOX ABOVE.
Printed name of attorney licensed as escrow officer
Signature of attorney (by signing attorney confirms escrow oｉｉｌｆｈｕ＃ｄｓｓｏｌｆｄｑｗﾶｖ＃ｖｗｄｗｘｖ＃ｒｉ＃ｈｐｓｏｒ｜ｐｈｑｗ，＃
Sworn to and subscribed before me on ______________________________ to certify which witness my hand and seal of
office.
(Notary Seal)
Nｒｗｄｕ｜＃Ｓｘｅｏｌｆﾶｖ＃Ｖｌｊｑｄｗｘｕｈ＃
Reminder: Securing the issuance of this license based upon a false, fictitious, or fraudulent statement or entry with regard to any material fact is subject to both disciplinary action and criminal prosecution.
PC132 Rev. 08/11 |
Page 2 of 4 |
22.County(ies) in which you intend to act as an escrow officer
(MUST BE A COUNTY(IES) IN WHICH THE TITLE AGENT/DIRECT OPERATION SHOWN ON SECTION B IS LICENSED TO OPERATE)
23.Give complete details of all (including current) employment,
(5) years.
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Employer Name |
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Employer Address (Street, City, State, Zip) |
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Title/Position |
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24.Give the name, street address and phone number of three (3) business or professional references from the community where you have resided for the last five years.
Name |
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Address (Street, City, State, Zip) |
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Phone |
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Type of Business |
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25.Do you understand you are not to act as an escrow officer until (1) the title agent/direct operation appointing you has actually received your license or has been notified by the Texas Department of Insurance that your license has been issued; or (2) you have been notified by the Texas Department of Insurance that your license has been issued?
26.HAVE YOU PERSONALLY ANSWERED AND UNDERSTOOD EACH QUESTION PERTAINING TO YOU ON THIS APPLICATION?
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YES
YES
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NO
NO
Reminder: Securing the issuance of this license based upon a false, fictitious, or fraudulent statement or entry with regard to any material fact is subject to both disciplinary action and criminal prosecution.
Print/Type Full Legal Name
CERTIFICATION
THE STATE OF _______________________
COUNTY OF __________________________
Before me, the undersigned authority, on this day personally appeared
known to me to be the affiant, who, after being placed on his/her oath, stated that he/she has read the preceding form and that the answers, exhibits and attachments forming it are true and correct as to any factual statements contained therein.
Signature of Affiant
Sworn to and subscribed before me on ______________________________ to certify which witness my hand and seal of
office.
(Notary Seal)
Notary Pｘｅｏｌｆﾶｖ＃Ｖｌｊｑｄｗｘｕｈ＃
NOTICE ABOUT CERTAIN INFORMATION LAWS AND PRACTICES
With few exceptions, you are entitled to be informed about the information the Texas Department of Insurance (TDI) collects about you. Under sections 552.021 and 552.023 of the Texas Government Code, you have a right to review or receive copies of information about yourself, including private information. However, TDI may withhold information for reasons other than to protect your right to privacy. Under section 559.004 of the Texas Government Code, you are entitled to request that TDI correct information that TDI has about you that is incorrect. For more information about the procedure and costs for obtaining information from TDI or about the procedure for correcting information kept by TDI, please contact the Agency Counsel Section of TDI's Legal Services Program at AgencyCounsel@tdi.state.texas.us or you may refer to the Corrections Procedure section on our Web sites.
PC132 Rev. 08/11 |
Page 3 of 4 |
SECTION B
Notice of Appointment of Escrow Officer by Title Insurance Agent/Direct Operation
Reminder: Securing the issuance of this license based upon a false, fictitious, or fraudulent statement or entry with regard to any material fact is subject to both disciplinary action and criminal prosecution.
This notice of appointment ofis for a license
to act as an escrow officer for the Title Insurance Agent/Direct Operation identified below. If and when the appointment is terminated or canceled, the Texas Department of Insurance will be properly notified.
The applicant is known to this Agent/Direct Operation to have a good business reputation, is worthy of the public trust, has reasonable experience or instruction in the field of title insurance and is qualified as an escrow officer as defined in the "Texas Title Insurance Act". I know of no fact or condition which would disqualify such applicant from receiving a license.
Appointing Title Insurance Agent/Direct Ｒｓｈｕｄｗｌｒｑ＃ｆｒｑｉｌｕｐｖ＃ｄｓｓｏｌｆｄｑｗﾶｖ＃ｖｗｄｗｘｖ＃ｒｉ＃ｈｐｓｏｒ｜ｐｈｑｗ＃ｌｑｇｌｆｄｗｈｇ＃ｌｑ＃Ｖｈｆｗｌｒｑ＃Ｄ＃Ｑｒ１＃５４＃ of this application.
Ｄｓｓｒｌｑｗｌｑｊ＃Ｗｌｗｏｈ＃Ｌｑｖｘｕｄｑｆｈ＃Ｄｊｈｑｗ２Ｇｌｕｈｆｗ＃Ｒｓｈｕｄｗｌｒｑ＃ｆｒｑｉｌｕｐｖ＃ｄｓｓｏｌｆｄｑｗﾶｖ＃ｆｒｘｑｗ｜＋ｌｈｖ，＃ｒｉ＃ｒｓｈｕｄｗｌｒｑ＃ｄｖ＃ｌｑｇｌｆｄｗｈｇ＃ｌｑ＃Ｖｈｆｗｌｒｑ＃Ｄ＃ No. 22 of this application.
Appointing Title Insurance Agent/Direct Operation confirms it will not allow the applicant to act as an escrow officer until the Title Insurance Escrow Officer License has been issued by the Texas Department of Insurance.
Appointing Title Insurance Agent's/Dｌｕｈｆｗ＃Ｒｓｈｕｄｗｌｒｑﾶｖ＃Ｗｈ｛ｄｖ＃Ｇｈｓｄｕｗｐｈｑｗ＃ｒｉ＃Ｌｑｖｘｕｄｑｆｈ＃Ｆｒｐｓｄｑ｜＃＆＃
Name of Title Agent/Direct Operation Contact Person |
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Name of Appointing Title Agent/Direct Operation |
Mailing Address (P. O. Box/Street) |
City, State, Zip |
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Full Name of Title Agent/Direct Operation Appointing Official |
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Title of Appointing Official |
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CERTIFICATION
THE STATE OF _______________________
COUNTY OF __________________________
Before me, the undersigned authority, on this day personally appeared
known to me to be the affiant, who, after being placed on his/her oath, stated that he/she has read the preceding form and that the answers, exhibits and attachments forming it are true and correct as to any factual statements contained therein.
Signature of Affiant
Sworn to and subscribed before me on ______________________________ to certify which witness my hand and seal of
office.
(Notary Seal)
Notary Ｓｘｅｏｌｆﾶｖ＃Ｖｌｊｑｄｗｘｕｈ＃
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Regular Mailing Address |
Overnight Mailing Address |
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Texas Department of Insurance |
Texas Department of Insurance |
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Title Division, Mail Code |
Title Division, Mail Code |
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P.O. Box 149104 |
333 Guadalupe Street |
Refer Questions To: (512) |
Austin, Texas |
Austin, Texas 78701 |
PC132 Rev. 08/11 |
Page 4 of 4 |
More PDF Templates
Tx Franchise - Enter the physical location's name and address of your outlet.
Lawsuit Document - Check the appropriate box to identify the specific case type.
Common mistakes
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Incomplete Personal Information: Failing to provide complete personal details, such as the full name or social security number, can lead to delays in processing the application.
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Missing Signature: Not signing the form or having the required signatures from the employer attorney can result in immediate rejection of the application.
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Incorrect Employment History: Providing inaccurate or incomplete information regarding employment history over the last five years can raise red flags during the review process.
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Omitting Criminal History Details: Not disclosing pending charges or past convictions, even if they seem minor, can lead to serious consequences, including denial of the application.
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Neglecting to Attach Required Documents: Forgetting to include necessary documents, such as the Texas escrow officer's schedule bond, can halt the application process.
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Failure to Understand the Licensing Requirements: Not fully grasping the stipulations regarding when one can act as an escrow officer can lead to violations and potential disciplinary action.
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Ignoring Notification Requirements: Not providing a valid email address for notification purposes can result in missed communications regarding the application status.
Key takeaways
Here are key takeaways regarding the Texas PC132 form:
- Complete Sections A and B: The applicant must fill out Section A, while the sponsoring title agent or direct operation is responsible for Section B.
- Licensing Fee: A fee of $35.00 is required to process the application.
- Bond Requirements: If necessary, attach the Texas escrow officer's schedule bond. If a bond is already on file, include any required riders or endorsements.
- Fingerprinting: Fingerprints and criminal history information must be submitted as part of the application process.
- Disclosure of Criminal History: Applicants must disclose any pending or past misdemeanor or felony charges, including details about convictions and probation.
- Employment Verification: A complete employment history for the last five years must be provided, detailing all positions held.
- References: Three professional references from the community where the applicant has resided for the last five years are required.
- Acting as Escrow Officer: It is illegal to act as an escrow officer before receiving the license. Violations may result in fines or license denial.
- Notification Requirement: The applicant must not act as an escrow officer until they receive confirmation that the license has been issued by the Texas Department of Insurance.
Steps to Using Texas Pc132
Completing the Texas PC132 form requires careful attention to detail. This form is essential for those seeking to become licensed escrow officers in Texas. It is crucial to ensure that all sections are accurately filled out, as any discrepancies may delay the processing of your application.
- Begin by filling out Section A, which is for the escrow officer identification. Provide your full name, residence address, phone number, email address, and social security number. Make sure to include your date of birth and driver's license information.
- Indicate your marital status and answer questions regarding any pending charges or past convictions. It is important to be truthful in this section.
- Complete the employment history section, detailing your last five years of employment. Include the names and addresses of your employers, along with your job titles.
- Provide the names and contact information for three professional references from your community.
- In Section B, the sponsoring title agent or direct operation must complete their portion. This includes providing the name of the title agent, contact person, and mailing address.
- Attach the required licensing fee of $35.00 and, if necessary, include the Texas escrow officer's schedule bond. If a bond is already on file, ensure that any relevant rider or endorsement is attached.
- Submit your fingerprints and any criminal history information as specified in the addendum regarding requirements.
- Finally, review the entire form for accuracy and completeness before signing it. Ensure that the notary section is filled out appropriately.
Once the form is completed and submitted, the Texas Department of Insurance will review your application. You will be notified regarding the status of your license. It is advisable to keep a copy of your completed form for your records.