Form T-G1 - Policy Guaranty Fee Remittance 3 Dollars
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1POLICY GUARANTY FEE REMITTANCE FORM (T-G1)
By: _______________________________________________
___________________________________
(Name of Reporting Entity)
(Phone Number)
__________________________________________________
___________________________________
(Address)
(Firm ID Number-REQUIRED)
TX
__________________________________________________
____________________________________
(City, State, and Zip)
(e-mail address)
Check here if any of the information above has changed since your last remittance.
Check here if you are ceasing operations and this is a final remittance to TTIGA.
For the Quarter:
April 1
June 30
Beginning: ____________________, 20_____
Ending: ____________________, 20_____
16
16
July 1
September 30
$_________
Owner’s and Loan Policies Co
During Quarter: ________
X $3.00 =
0.00
If you had no closings during the quarter and no policy guaranty fees were received, please
enter “0” and then sign and mail this form.
0.00
Total Remittance of Policy Guaranty Fee = $______________________________
I, _______________________________ of _________________________________________
do hereby certify that the above and foregoing is correct in all respect and correctly reflects all owner’s
and loan policies of title insurance required to be reported and counted in determining the quarterly policy
guaranty fees due by ________________________ pursuant to Texas Insurance Code §2602.151.
August 1,
2016
November 1,
________________________________________________
Signature
Printed Name & Position____________________________
Contact Number ___________________________________
SUBSCRIBED AND SWORN TO BEFORE ME, the undersigned authority, this the
________ day of _______________________ 20____.
___________________________________
Notary Public in and for the State of Texas
___________________________________
Printed Name of Notary
REMIT CHECK MADE PAYABLE TO:
FOR MAIL AND OVERNIGHT DELIVERY:
Texas Title Insurance Guaranty Association
Texas Title Insurance Guaranty Association
500 W. 5th St., STE 1150
Austin, TX 78701-3835
Note: This remittance and check or money order are due as follows:
Calendar Quarter Ending
Remittance Due Dates
June 30
August 1
September 30
November 1
December 31
February 1
March 31
May 1
TDI Form No. T-G1, Effective: 4/1/2016
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