The Texas PC132 form is a crucial document required for individuals seeking to obtain an escrow officer license in the state of Texas. This form facilitates the application process by collecting essential information about the applicant, including personal identification, employment history, and any legal issues that may affect their eligibility. Understanding the requirements and implications of the PC132 form is vital for aspiring escrow officers to ensure compliance with state regulations.
The Texas PC132 form is a crucial document for individuals seeking to obtain a license as an escrow officer in the state of Texas. This form is issued by the Texas Department of Insurance and serves multiple purposes throughout the licensing process. Applicants must provide personal information, including their full name, residence address, and social security number, as well as details about their employment history and any criminal background. Additionally, the form requires the completion of specific sections by both the applicant and their sponsoring title agent or direct operation. A licensing fee is also mandated, along with the submission of a Texas escrow officer's schedule bond if necessary. The form emphasizes the importance of honesty and accuracy, as providing false information can lead to disciplinary action or criminal prosecution. Furthermore, applicants are reminded that they cannot act as escrow officers until their license has been officially issued. This form not only facilitates the licensing process but also ensures that escrow officers meet the necessary qualifications to serve the public effectively.
TDI USE ONLY
FPCARD: ﾅ
Texas Department of Insurance
CO. ID:
LIC.#:
Property & Casualty Program - Title Division, Mail Code 106-2T
PID:
EXP:
333 Guadalupe ｺ P. O. Box 149104, Austin, Texas 78714-9104
ISSUE:
RIDER:
ﾅ
512-322-3482 telephone ｺ 512-305-7426 fax ｺ www.tdi.texas.gov
R.R.#:
OTHER:
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 -- ESCROW OFFICER IDENTIFICATION
Mr.
1.
Name in full: Mrs. Last
First
Middle
Ms.
(No initials accepted)
2.
Residence Address
City
State
Zip
Phone No. (
)
3.
E-Mail Address
(required for notification purposes)
4. Social Security Number
5. Texas Resident
(Disclosure of Social Security Number is required by the Texas Family Code §231.302)
6.
Date of Birth
7. Driver's License #
(MM
DD YYYY)
8.
Marital Status
Single
Married
Divorced
Widowed
ﾅYes
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
the federal government?
*ﾅ YES
b. have you ever been convicted of any misdemeanor or felony offense in Texas, any other
state, or by the federal government?
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?
d. have you ever served any period or probation for any misdemeanor or felony offense in
Texas, any other state, or by the federal government?
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
refused, suspended or revoked in Texas or any other state?
ﾅ YES
ﾅ NO
11.
Are you now indebted to a special deputy receiver of the Texas Department of Insurance,
any insurance company, general agent or agent?
12.
Have you ever had an agency contract canceled for cause (e.g., misrepresentation,
misappropriation, etc.)?
13.
Have you ever been placed under injunction or restraining order of a court or regulatory
agency in respect to violation of any federal or state law relating to insurance or securities?
14.
Do you now have pending litigation against you alleging violation of the Texas Insurance Code
or the insurance laws of any other state?
15.
Have you ever held ownership interest in any insurance agency or company?
16.
Do you have any judgments against you held by any insurance company or insured which
are unpaid in whole or in part?
17.
Do you have any judgments against you which involved violation of the Texas Insurance Code
18.
Do you have another business name or alias?
If YES, indicate business name or alias here:
19.
Have you ever held a professional license, insurance license or company appointment under
any other name?
If YES, indicate other name(s) here:
20. Do you currently hold an escrow officer license?
YES
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.
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, self-employment, or unemployment during the last five
(5) years.
Dates
Employer Name
Employer Address (Street, City, State, Zip)
Title/Position
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
Address (Street, City, State, Zip)
Phone
Type of Business
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?
NO
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
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.
Page 3 of 4
SECTION B -- TITLE AGENT IDENTIFICATION AND CERTIFICATION
Notice of Appointment of Escrow Officer by Title Insurance Agent/Direct Operation
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
Ｆｒｑｗｄｆｗ＃Ｓｈｕｖｒｑﾶｖ＃ｈ-mail address (required for notification purposes)
Name of Appointing Title Agent/Direct Operation
Mailing Address (P. O. Box/Street)
City, State, Zip
Full Name of Title Agent/Direct Operation Appointing Official
Title of Appointing Official
Notary Ｓｘｅｏｌｆﾶｖ＃Ｖｌｊｑｄｗｘｕｈ＃
Regular Mailing Address
Overnight Mailing Address
Title Division, Mail Code 106-2T
P.O. Box 149104
333 Guadalupe Street
Refer Questions To: (512) 322-3482
Austin, Texas 78714-9104
Austin, Texas 78701
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