The Texas Department of Insurance adopts and incorporates herein by reference standard administrator forms for use in the regulation and exemption from regulation of administrators. Applicants and licensed administrators are required to utilize these forms in preparing applications, notification of exemptions, statements, notices of required information, and other submissions required under the Insurance Code, Article 21.07-6, and this subchapter. These forms are published by the Texas Department of Insurance and may be obtained from the Third-Party Administrator Unit, Mail Code 105-6A, Texas Department of Insurance, P.O. Box 149104, 333 Guadalupe, Austin, Texas 78714-9104. These forms are more specifically identified in paragraphs (1)-(9) of this subsection:

1. (1) TPA Form Number 1, Name Application;
2. (2) TPA Form Number 1A, Assumed Name Certificate;
3. (3) TPA Form Number 2, Application for Certificate of Authority;
4. (4) TPA Form Number 2A, Supplemental Information/Annual Report;
5. (5) TPA Form Number 3, Officers and Directors Page;
6. (6) TPA Form Number 4, Biographical Affidavit;
7. (7) TPA Form Number 5, Service of Process;
8. (8) TPA Form Number 6, Identification and Reporting of Certain Insurers and Health Maintenance Organizations; and
9. (9) TPA Form Number 7, Notification of Exemption Form.

Source Note:The provisions of this §7.1602 adopted to be effective September 14, 1994, 19 TexReg 6855.