THIS FORM IS TO BE USED TO CHANGE THE FOLLOWING: - tdi texas 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your TDI License Number exactly as it appears on your license or renewal application in the designated field.
3. Next, provide the Name of Agent/Agency, ensuring it matches the name on your license.
4. If you are requesting a name change, fill in the new name and attach any required supporting documentation such as a marriage certificate or divorce decree.
5. Complete the Mailing Address section with your official address for notifications. Ensure all fields are filled accurately.
6. For individuals, fill out the Resident Address section with your current living address. Remember that P.O. Boxes are not allowed here.
7. Provide your Business Address if applicable, noting that this is for reference only and will not be used for official correspondence.
8. Enter your Daytime Phone Number and E-mail Address for contact purposes.
9. Finally, sign and date the form before submitting it via mail, email, or fax to the Texas Department of Insurance.

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