| (a) An applicant for a license or a registration must submit all required information on official application forms prescribed by the department and submit the required application fee and the initial license or registration fee. (b) The application form shall contain the following information: (1) specific information regarding personal data; full legal name of individual or business entity; date of birth; social security number; taxpayer identification number; information regarding other licenses, registrations, permits, and certifications held by applicant; and information regarding misdemeanor and felony convictions of the applicant; (2) trade names and addresses of all locations and branch offices at which the applicant intends to conduct business; (3) if the applicant is a corporation or other business entity, specific information regarding type of ownership, registered address, and names and addresses of all officers, directors, registered agents and major shareholders; (4) if the applicant is a corporation, a current Certificate of Existence or Certificate of Authority issued by the Texas Secretary of State and a current letter from the Texas Comptroller of Public Accounts verifying that the corporation is current in the payment of franchise taxes; (5) a statement that the applicant has read the Act and these rules; (6) a statement that the applicant, if issued a license or registration, shall return the license or registration to the department upon revocation or suspension of the license or registration or upon lawful demand; (7) a statement that the applicant understands that fees and materials submitted in the application process are nonrefundable and nonreturnable; (8) a statement that the applicant agrees to comply with all state and federal laws and regulations regarding the sale and delivery of personal emergency response system services; (9) a statement that the applicant meets the qualifications prescribed by the Act for a license or registration; (10) a statement that the information contained in the application is truthful and complete; (11) if the applicant is a corporation or other business entity, evidence of a general liability insurance policy on a certificate of insurance form prescribed by the department and countersigned by an insurance agent licensed in this state or a certificate of insurance for surplus lines coverage obtained under Insurance Code, Article 1.14-2, through a licensed Texas surplus lines agent resident in this state; (12) if the applicant is a corporation or other business entity, a statement regarding the method by which monitoring services will be provided; and (13) the signature of the applicant. |
