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5 telephone 512-490-1035 fax www.tdi.texas.gov ANNUAL AGENT REPORT FOR RISK RETENTION AND PURCHASING GROUPS Year Ending: Pursuant to Chapter 2201.007, Texas Insurance Code, an agent representing a risk retention or purchasing group is required to report to the Commissioner the activities and scope of services being provided to the group by March 1 of each year. A copy of this report should be retained for your files. Please TYPE or PRINT. 1. Name of Agent/Agency Agent Add.

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