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Entity Name Change / Assumed Name (DBA) Request Form
Use this form to register assumed names of currently licensed people and entities. You may also use it to
change the official name of a currently licensed entity.
Filing fee for reinsurance intermediary: $500
Filing fee for other agents or entities: $50
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What are you registering?
Assumed name Official name change of licensed entity
Agent’s or entity’s TDI license number ___________________________________________
Social Security number of the agent or Federal Employer Identification
Number (FEIN) of the entity:
___________________________
Name of agent or entity: _____________________________________________________________________________
Enter the exact name as shown on your license. Do not put assumed name or new entity name in this space.
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Assumed name or new name of entity
_________________________________________________________________________________________________________________
To register an a
ssumed name, enter the exact assumed name as it's shown on the assumed name
certificate. To register an entity name change, enter the exact new name of entity as it's reflected in the
entity’s official name change document.
Assumed name means any name other than a true name or present legal name. You must attach a
copy of an assumed name certificate that has been filed with the county clerk’s office of the county in which
the assumed name will be used if the assumed name:
• In the case of a person, is a name that does not include the person's last name or family name.
• In the case of a partnership, is a name that does not include the last name or other legal name of
each partner.
• In the case of a person or partnership, is a name, including a last name, that suggests the existence
of additional owners by including words such as “Company,” “& Company,” “& Sons,” “&
Associates,” “Brothers,” or similar words, but not words that merely describe the business or
professional service.
• In the case of a limited partnership (LP), a corporation, a limited liability partnership (LLP), or a limited
liability company (LLC), any name other than the name in its certificate of formation or a comparable
document. A corporation, LP, LLP, or LLC may file a copy of assumed name certificate that has been
filed with the Texas Secretary of State rather than the county clerk.