Ldtl registration form - Texas Department of Insurance - Texas 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the designated field. Ensure that it matches exactly as it appears on your license.
3. Fill in your mailing address, ensuring all details are accurate for correspondence.
4. Input your license number and email address in the respective fields.
5. Select the appropriate box under item 5 to indicate whether you are applying for an exemption or an extension. If applying for an exemption, confirm your continuous licensure status.
6. If requesting an extension, attach any required documentation as specified in section 5.b. (A)-(F) to support your request.
7. Sign and date the form at the bottom before submitting it to ensure its validity.

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