Get Texas Department Of Insurance Ccrc Form

This guide provides a clear and comprehensive overview of how to complete the Texas Department Of Insurance Continuing Care Retirement Community (CCRC) Biographical Data Form online. By following these instructions, users can ensure that they fill out the form accurately and efficiently.

Follow the steps to complete the form effectively

1. Click ‘Get Form’ button to obtain the form and access it online.
2. Begin filling out the form by entering the full legal name, residence address, and business address of the continuing care retirement community. Ensure that these details do not include group names.
3. Respond to questions regarding name changes, including the reason for the change and any other names used previously.
4. Provide your date of birth and place of birth.
5. Enter your Social Security Number, keeping in mind to adhere to the specified privacy guidelines.
6. List your educational background, indicating the names of schools, locations, and dates attended for high school, college, and any graduate or professional degrees.
7. Detail your current or proposed position with the CCRC and indicate how long you have been with the organization.
8. Provide a complete employment history for the past 20 years, including job titles and responsibilities.
9. Answer whether your current employer or any former employers may be contacted regarding your employment history.
10. Indicate if you or your spouse own stock in the CCRC and provide details if applicable.
11. Clarify whether you or your spouse hold stock of 10% or more in any business entities and provide the names and percentages.
12. Describe any anticipated transactions between the CCRC and any business entities in which you may have a significant interest.
13. Disclose any past associations with other CCRCs or insurance companies and provide explanations in detail.
14. Indicate if you or your spouse have ever been adjudicated as bankrupt or involved in criminal offenses, along with detailed explanations.
15. Provide information regarding any licenses that have been refused, suspended, or revoked by any licensing agency.
16. Explain if you have ever been linked to any CCRC or insurance company that became insolvent.
17. Mention if you or your spouse have been licensed as insurance agents, including the duration of the license.
18. Disclose if you or your spouse have had licenses to sell securities or real estate, including details of any suspensions or revocations.
19. Provide details if you have held a position requiring a fidelity bond and whether any claims were made against that bond.
20. Respond to questions about past involvements with companies cited for violations by state regulatory bodies.
21. Finalize the form by signing and dating it, ensuring that original signatures are included as copies are not accepted.
22. After completing all sections, save changes, download, print, or share the completed form as needed to submit it to the Texas Department of Insurance.

Complete your documents online today to ensure smooth processing.