debt cancellation agreement forms approved by...
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Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedAeverex GPW 0132-0920B-TX 11/26/2013
Aeverex GPW 0132-1001B-TX 11/26/2013
Aeverex GPW 0132-1007B-TX 11/26/2013
Aeverex GPW 0132-0820B 11/26/2013
Aeverex GPW 0132-1001B 11/26/2013
Aeverex GPW 0132-1007B 11/26/2013
Aeverex General Agency, Inc. GPW 0142-1229B 02/12/2015
Allstate Dealer Services FP2350 1012 07/17/2012
Allstate Dealer Services FP2351 1012 07/17/2012
Allstate Dealer Services FP2354 1012 07/17/2012
Allstate Dealer Services FP2355 1012 07/17/2012
Allstate Dealer Services FP2358 1012 07/17/2012
Allstate Dealer Services FP2359 1012 07/17/2012
Allstate Dealer Services FP2599 0613 07/17/2013
Allstate Dealer Services FP2674 0613 07/17/2013
Allstate Dealer Services FP2675 0613 07/17/2013
Allstate Dealer Services ( E.R.J. Insurance Group, Inc. ) FP2643 0113 03/08/2013
American Assurance Corporation GAPAAC-Waiver150 (10/14)-TX 01/29/2015
American Auto Guardian, Inc. AAGI-ANICO-GAP-NF-TX (01/13) 01/09/2013
American Auto Guardian, Inc. AAGI-ANICO-GAP-TF-TX (01/13) 01/09/2013
American Auto Guardian, Inc. AAGI-ANICO-GAP-TX (01/13) 01/09/2013
American Auto Guardian, Inc. FP2573 0212 03/06/2012
American Auto Guardian, Inc. FP2574 0212 03/06/2012
American Auto Guardian, Inc. FP2575 0212 03/06/2012
American Colonial Administration, LLC AR2570 1011 04/03/2012
American Colonial Administration, LLC AR2571 1011 04/03/2012
American Colonial Administration, LLC AR2575 1011 04/03/2012
American Colonial Administration, LLC FP2570 1011 01/20/2012
American Colonial Administration, LLC FP2571 1011 01/20/2012
American Colonial Administration, LLC FP2575 1011 01/20/2012
American Colonial Administration, LLC (First Dealer Resources, LLC) AR2570 1213 02/12/2014
American Colonial Administration, LLC (First Dealer Resources, LLC) AR2575 1213 02/12/2014
American Colonial Administration, LLC (First Dealer Resources, LLC) FP2420 0413 11/19/2013
American Colonial Administration, LLC (First Dealer Resources, LLC) FP2423 0413 11/19/2013
American Financial & Automotive Services, Inc. AFAS-0106 Rev 6/13 09/05/2013
American Financial & Automotive Services, Inc. AFAS-0107 rev (06/12) 09/13/2012
American Financial & Automotive Services, Inc. AFAS-0108 rev (06/12) 09/13/2012
American Financial & Automotive Services, Inc. AFAS-0106 rev (01/12) 03/06/2012
American Financial & Automotive Services, Inc. AFAS-0107 rev (01/12) 02/22/2012
American Financial & Automotive Services, Inc. AFAS-0108 rev (01/12) 02/22/2012
Page 1of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedAmerican Financial & Automotive Services, Inc. AFAS-0106 12/22/2011
American Financial & Automotive Services, Inc. AFAS-0107 12/22/2011
American Financial & Automotive Services, Inc. AFAS-0108 12/22/2011
American Financial Warranty Corporation MTGAP-0103 Rev. 1/16 02/17/2016
American Financial Warranty Corporation MTGAP-0104 Rev. 1/16 02/17/2016
American Financial Warranty Corporation MTGAP-0107 Rev. 1/16 01/08/2016
American Financial Warranty Corporation MTGAP-0103 Rev. 8/15 08/07/2015
American Financial Warranty Corporation MTGAP-0104 Rev. 08/15 08/07/2015
American Financial Warranty Corporation MTGAP-0107 Rev. 8/15 08/07/2015
American Guardian Warranty Services, Inc. AG Base GW VS TX FMC_02.16 03/28/2016
American Guardian Warranty Services, Inc. AG Base GW VS TX_11.15 11/20/2015
American Guardian Warranty Services AG Base GW VS (04.13) TX 06/28/2013
American Guardian Warranty Services AG-VSC-RGW (05.12) TX 08/10/2012
American National Administrators, Inc. AT125NTX 10/13/2011
American National Administrators, Inc. AT125TX 10/13/2011
American National Administrators, Inc. AT150FTTX 10/13/2011
American National Administrators, Inc. AT150TX 10/13/2011
AMT Warranty Corp. 11GGCC0115_150_TX 05/22/2015
AMT Warranty Corp. 11GGAP0513_TX_150 05/23/2013
AmTrust North America (Warrantach Automotive, Inc) 11CGAP0313_TX_150 02/27/2013
AmTrust North America, Inc. GAPADD-TX-009 (09-11) 11/21/2011
Apex Protection, Inc. GAP-TX1214-TFS REV A 04/29/2015
Apex Protection, Inc. GAP-TX0714-REV A 10/22/2014
Apex Protection, Inc. GAP-TX0714 09/03/2014
Arch Insurance Company GEN-19971-TX 12/11 01/25/2012
Assured Vehicle Protection, Inc. (AVP) AVP/GAP/TX/10-15 11/19/2015
Auto Trac System EFI150-M-001 [08/12] 10/16/2012
Automobile Protection Corporation (APCO) 8030126 (004) 03/12 03/15/2012
Automobile Protection Corporation (APCO) 8030123 (002) 10/11 11/22/2011
Automobile Protection Corporation (APCO) 8030124 (007) 10/11 10/13/2011
Automobile Protection Corporation (APCO) 8030122 (007) 09/11 10/13/2011
Automotive Warranty Services, Inc. AUTOGUARD-109 TX (01/15) 05/15/2015
Automotive Warranty Services, Inc. AUTOGUARD-109 TFS TX (01/15) 05/15/2015
Berkshire Risk Services TXGAP0314 04/25/2014
Berkshire Risk Services No Form # 04/25/2014
Berkshire Risk Services, LLC BRS-TXDCA 1001413-Holder 12/04/2013
CALL GAP Ltd. d/b/a Gap Insurance Services
Extreme GAP ETXF150-M-001 07-11
(also numbered as Form 2012) 03/09/2012
Page 2of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date Approved
CALL GAP Ltd. d/b/a Gap Insurance Services
Extreme GAP ETXG125-M-001 07-11
(also numbered as Form 1933) 03/09/2012
CALL GAP Ltd. d/b/a Gap Insurance Services
Extreme GAP ETXG150-M-001 07-11
(also numbered as Form 1933) 03/09/2012
CALL GAP Ltd. d/b/a Gap Insurance Services 150% TX 01/11/2012
Cal-Tex Protective Coatings Inc. d/b/a Automotive Protection Systems, Inc. GAP-CTPC Texas Rev. 140325 04/25/2014
Cal-Tex Protective Coatings Inc. d/b/a Automotive Protection Systems, Inc. GAP-CTPC Texas Rev. 140325 04/25/2014
Caregard Warranty Services TX.TY150 12/20/2011
Caregard Warranty Services TX334 12/20/2011
Caregard Warranty Services TX346 12/20/2011
Caregard Warranty Services TX733 12/20/2011
Carr Products Administrative Services, LLC ACVLegaltexas125 1-12 03/07/2012
Centrus Auto Finance, LLC DCA-9-2011 10/13/2011
Centrus Auto Finance, LLC DBA MarkOne Financial DCA-01-2015 02/20/2015
CIG Financial, LLC CIG DCA VER 092015 09/11/2015
CNA National Warranty Corporation 6932 (10/12) ( also numbered GPRTX) 09/21/2012
CNA National Warranty Corporation 6932 (10/12) (also numbered GPRTX) 09/21/2012
CNA National Warranty Corporation 6932 (10/11) 11/21/2011
Comprehensive Auto Resources Company, Inc. (CARco) CRO-TX (09-14) 11/14/2014
Comprehensive Auto Resources Company, Inc. (CARco) GRCARTX (05/14) 06/30/2014
Comprehensive Auto Resources Company, Inc. (CARco) TX125 (04/14) 05/30/2014
Comprehensive Auto Resources Company, Inc. (CARco) TX150 (04/14) 05/30/2014
Comprehensive Auto Resources Company, Inc. (CARco) TX150NF (04/14) 05/30/2014
Comprehensive Auto Resources Company, Inc. (CARco) GCARTX125-M-001 04/15/2014
Comprehensive Auto Resources Company, Inc. (CARco) GCARTX150-M-001 02/14 04/15/2014
Comprehensive Auto Resources Company, Inc. (CARco) GCARTX150-NF-M-001 02/14 04/15/2014
Comprehensive Auto Resources Company, Inc. (CARco) RV-TX Rev. 10/12 12/03/2012
Comprehensive Auto Resources Company, Inc. (CARco) CARTX150NF-M-001 (7/11) 10/15/2011
Comprehensive Auto Resources Company, Inc. (CARco) CARTX150-M-001 (7/11) 10/14/2011
Comprehensive Auto Resources Company, Inc. (CARco) CARTX125-M-001 (7/11) 10/13/2011
CornerStone United Inc. CSAGBTX125-R-002 (05/15) 07/17/2015
CornerStone United Inc. CSAGBTX150-R-002 (05/15) 07/17/2015
CornerStone United Inc. CSAGFTX150-R-002 (05/15) 07/17/2015
CornerStone United Inc. CSAGBTX125-M-002 (10/11) 10/13/2011
CornerStone United Inc. CSAGBTX150-M-002 (10/11) 10/13/2011
CornerStone United Inc. CSAGFTX150-M-002 (10/11) 10/13/2011
Creditor's Captive Formation Corporation V.2.2 TX 04/19/2012
D&P Holdings, Inc. EFTX150-WESC-001 07/26/2013
D&P Holdings, Inc. GFTX150-WESC-001 07/26/2013
D&P Holdings, Inc. EXTX150-WESC-001 rev (05/13) 05/22/2013
Page 3of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedD&P Holdings, Inc. GGTX150-WESC-001 rev (05/13) 05/22/2013
D&P Holdings, Inc. ETXT150-M-001 (3/12) 04/30/2012
D&P Holdings, Inc. STTX150-M-001 (3/12) 04/30/2012
D&P Holdings, Inc. RTXF150-M-001 03/09/2012
D&P Holdings, Inc. RTXG125-M-001 03/09/2012
D&P Holdings, Inc. RTXG150-M-001 03/09/2012
D&P Holdings, Inc. SGTF 150-M-001 01/12/2012
D&P Holdings, Inc. SGTX 125-M-001 01/12/2012
D&P Holdings, Inc. SGTX 150-M-001 01/12/2012
D&P Holdings, Inc. ETXF150-M-001 10/14/2011
D&P Holdings, Inc. ETXG125-M-001 10/14/2011
D&P Holdings, Inc. ETXG150-M-001 10/14/2011
D&P Holdings, Inc. GTXF150-M-001 10/14/2011
D&P Holdings, Inc. GTXG125-M-001 10/14/2011
D&P Holdings, Inc. GTXG150-M-001 10/14/2011
D&P Holdings, Inc. NTXF150-M-001 10/14/2011
D&P Holdings, Inc. NTXG125-M-001 10/14/2011
D&P Holdings, Inc. NTXG150-M-001 10/14/2011
D&P Holdings, Inc. TTX125-M-001 10/14/2011
D&P Holdings, Inc. d/b/a Auto Trac System, d/b/a Diversified Insurance Facilities ETXF150-R-001 04/15 05/26/2015
D&P Holdings, Inc. d/b/a Auto Trac System, d/b/a Diversified Insurance Facilities ETXG125-R-001 04/15 05/26/2015
D&P Holdings, Inc. d/b/a Auto Trac System, d/b/a Diversified Insurance Facilities SGTXG150-R-001 04/15 05/26/2015
D&P Holdings, Inc. d/b/a Auto Trac System, d/b/a Diversified Insurance Facilities SGTXG125-R-001 04/15 05/26/2015
D&P Holdings, Inc. d/b/a Auto Trac System, d/b/a Diversified Insurance Facilities SGTXF150-R-001 04/15 05/26/2015
D&P Holdings, Inc. d/b/a Auto Trac System, d/b/a Diversified Insurance Facilities GTXG150-R-001 04/15 05/26/2015
D&P Holdings, Inc. d/b/a Auto Trac System, d/b/a Diversified Insurance Facilities GTXF150-R-001 04/15 05/26/2015
D&P Holdings, Inc. d/b/a Auto Trac System, d/b/a Diversified Insurance Facilities GTXG125-R-001 04/15 05/26/2015
D&P Holdings, Inc. d/b/a Auto Trac System, d/b/a Diversified Insurance Facilities PKTXG-R-001 [07/15] 08/20/2015
D&P Holdings, Inc. dba Auto Trac System ETXG150-R-001 04/01/2015
Dealer Motor Services AT320 (also numbered as AT-TX 320) 06/08/2012
Dealer Motor Services AT344 (also numbered as AT-TX 344) 06/08/2012
Dealers Assurance Company (ForeSight Services Group, Inc.) GAP-FGTX-T-ADDM 0216 03/03/2016
E.R.J. Insurance Group d/b/a American Heritage Insurance Services FP2874 0316 04/07/2016
E.R.J. Insurance Group d/b/a American Heritage Insurance Services FP2811 0915 01/08/2016
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2500 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2501 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2502 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2503 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2504 1011 10/14/2011
Page 4of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedE.R.J. Insurance Group d/b/a American Heritage Insurance Services 2505 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2506 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2507 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2508 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2509 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2510 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2511 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2512 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2513 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2514 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2515 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2516 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2517 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2518 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2519 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2520 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2521 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2522 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2523 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2524 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2525 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2526 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2527 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2528 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2529 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2530 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2531 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2533 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2534 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2535 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2536 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2537 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2538 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2539 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2540 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2541 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2542 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2543 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2544 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2545 1011 10/14/2011
Page 5of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedE.R.J. Insurance Group d/b/a American Heritage Insurance Services 2546 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2514 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2523 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2580 1011 10/14/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services FP2552 12/08/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services FP2553 12/08/2011
E.R.J. Insurance Group d/b/a American Heritage Insurance Services FP2554 12/08/2011
Enterprise Financial Group, Inc. GAP-WAIVER TX (0914) RL 12/12/2014
Enterprise Financial Group, Inc. GAP-WAIVER-150% PRB TX (08/12) 09/25/2012
Enterprise Financial Group, Inc. GAP-WAIVER 125% PR TX (10/11) EFG 08/14/2012
Enterprise Financial Group, Inc. GAP-WAIVER 125% PR TX (10/11) ORL 08/14/2012
Enterprise Financial Group, Inc. GAP-WAIVER 125% PR TX (10/11) SG 08/14/2012
Enterprise Financial Group, Inc. GAP-WAIVER-150% PR TX (10/11) 06/28/2012
Enterprise Financial Group, Inc. GAP-WAIVER-125% PR TX (10/11) 12/08/2011
Enterprise Financial Group, Inc. GAP-WAIVER-125% PR TX (10/11) ORL 12/08/2011
Enterprise Financial Group, Inc. GAP-WAIVER-125% PR TX (10/11) SG 12/08/2011
Enterprise Financial Group, Inc. GAP-WAIVER-150% PR TX (10/11) 12/08/2011
Ethos Group, Inc.
101010-61000-TX-20120817
(also numbered as EG202-A) 08/17/2012
Ethos Group, Inc.
101010-61000-TX-FD-20120816
(also numbered as EG202 FORD) 08/17/2012
Ethos Group, Inc.
101010-61000-TX-GO-20120817
(also numbered as EG202-GO) 08/17/2012
Ethos Group, Inc. EG-AT125NTX(10/14) 12/29/2014
Ethos Group, Inc. EG-AT125TX(10/14) 12/29/2014
Ethos Group, Inc. EG-AT150FTTX(10/14) 12/29/2014
Ethos Group, Inc. EG-AT150TX(10/14) 12/29/2014
Ethos Group, Inc. EG-AT125NTX 01/12 02/22/2013
Ethos Group, Inc. EG-AT125TX 01/12 02/22/2013
Ethos Group, Inc. EG-AT150FTTX 01/12 02/22/2013
Ethos Group, Inc. EG-AT150TX 01/12 02/22/2013
Express Systems, Inc. GAP-VS-TX-TFS (7/14) 08/21/2014
Express Systems, Inc. GAP-VS-TX-TFS (3/12) 09/19/2012
Express Systems, Inc. GAP-VS-TX-FMCC (3/12) 06/14/2012
Express Systems, Inc. GAP-VS-TX (3/12) 04/27/2012
Express Systems, Inc. GAP-VS-TX-FMCC (3/12) 04/27/2012
Express Systems, Inc. GAP-VS-TX-TFS (3/12) 04/27/2012
Express Systems, Inc. GAP-VS-TXPC (8/11) 10/13/2011
Express Systems, Inc. GAP-VS-TXPC-FMCC (8/11) 10/13/2011
Express Systems, Inc. GAP-VS-TXPC-TFS (8/11) 10/13/2011
Page 6of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedFamily First Dealer Services, LLC CUDL125NFGAPTX 02/23/2012
Family First Dealer Services, LLC CUDL150DGAPTX 02/23/2012
Family First Dealer Services, LLC CUDL150FGAPTX 02/23/2012
Family First Dealer Services, LLC VERO125NFGAPTX 02/23/2012
Family First Dealer Services, LLC VERO150FGAPTX 02/23/2012
Family First Dealer Services, LLC VERO150TFSGAPTX 02/23/2012
Family First Dealer Services, LLC CUDL125NFGAP 02/02/2012
Family First Dealer Services, LLC CUDL150DGAP 02/02/2012
Family First Dealer Services, LLC CUDL150FGAP 02/02/2012
Family First Dealer Services, LLC VERO125NFGAP 02/02/2012
Family First Dealer Services, LLC VERO150FGAP 02/02/2012
Family First Dealer Services, LLC VERO150TFSGAP 02/02/2012
Family First Dealer Services, LLC FFDS125NFGAPTX 11/01/2011
Family First Dealer Services, LLC FFDS125SGAPTX 11/01/2011
Family First Dealer Services, LLC FFDS150SGAPTX 11/01/2011
Family First Dealer Services, LLC FFDS150TFSGAPTX 11/01/2011
Financial Gap Administrator, LLC FG162 1/16 3/1/2016
Financial Gap Administrator, LLC FG163 1/16 03/01/2016
Financial Gap Administrator LLC FC115 10/13 (also numbered APPTX) 11/19/2013
Financial Gap Administrator LLC FC405 10/13 (also numbered 150GATX) 11/19/2013
Financial Gap Administrator LLC FC406 10/13 (also numbered as 125GATX) 11/19/2013
Financial Gap Administrator LLC FA233 07/13 (also numbered as GWRVTX) 11/19/2013
Financial Gap Administrator LLC (Wise F&I LLC) FC116 03/14 (FAPPTX) 05/08/2014
Financial Gap Administrator LLC (Wise F&I LLC) FC423 03/14 (UGATX) 05/08/2014
Financial Gap Administrator LLC (Wise F&I LLC) FC426 03/14 (FGATX) 05/08/2014
Financial Gap Administrator LLC (Wise F&I LLC) FC116 11/13 (FAPPTX) [version 2] 02/18/2014
Financial Gap Administrator LLC (Wise F&I LLC) FC416 11/13 (FGATX) [version 2] 02/18/2014
Financial Gap Administrator LLC (Wise F&I LLC) FA246 11/13 (EPRVTX) 12/20/2013
Financial Gap Administrator LLC (Wise F&I LLC) FC116 11/13 (FAPPTX) 12/20/2013
Financial Gap Administrator LLC (Wise F&I LLC) FC416 11/13 (FGATX) 12/20/2013
Financial Gap Administrator LLC (Wise F&I LLC) FA233 07/13 (GWRVTX) 11/19/2013
Financial Gap Administrator LLC (Wise F&I LLC) FC115 10/13 11/19/2013
Financial Gap Administrator LLC (Wise F&I LLC) FC405 10/13 11/19/2013
Financial Gap Administrator LLC (Wise F&I LLC) FC406 10/13 11/19/2013
First American Service Corp. GAP-WAIVER-DEDREF125% PR TX (07/11) 10/13/2011
First American Service Corp. GAP-WAIVER-DEDREF150% PR TX (07/11) 10/13/2011
First American Service Corp. GAP-WAIVER-DEDREF125% PR TX (11/11) 12/29/2011
First American Service Corp. GAP-WAIVER-DEDREF150% PR TX (11/11) 12/29/2011
First Dealer Resources, LLC FP24200413 11/19/2013
Page 7of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedFirst Dealer Resources, LLC FP2423 0413 11/19/2013
First Dealer Resources, LLC FP2423 0413 06/12/2013
First Dealer Resources, LLC FP2419 0413 06/12/2013
First Dealer Resources, LLC FP2580 0413 06/12/2013
Ford Motor Credit Company FC-19971-TX 8/11 10/13/2011
Foresight Services Group, Inc. GAP-FGTX-T-ADDM 0615 06/17/2015
Foresight Services Group GAP-FGTX-F-ADDM 0714 09/10/2014
Foresight Services Group GAP-FGTX-ADDM 0714 09/10/2014
Fortega Financial Corp. FG125 GAP-TX 09/30/2014
Fortega Financial Corp. FG150 GAP-TX 09/30/2014
Frost Financial Services, Inc. GCTXRE0312 04/26/2012
GS Administrators, Inc. GPWTX0212 06/07/2012
GS Administrators, Inc. GPWTXAN0212 06/07/2012
GS Administrators, Inc. GPWTX1011 11/15/2011
Hyundai Protection Plan, Inc HYGP-TX rev 1/13 10/18/2012
Hyundai Protection Plan, Inc. HYGP-TX rev 4/15 02/20/2015
Innovative Aftermarket Systems, L.P. FP2840 1015 03/03/2016
Innovative Aftermarket Systems, L.P. FP2838 1015 02/23/2016
Innovative Aftermarket Systems L.P. AR2572 0415 07/16/2015
Innovative Aftermarket Systems L.P. AR2573 0415 07/16/2015
Innovative Aftermarket Systems L.P. GLTX 041015 04/15/2015
Innovative Aftermarket Systems L.P. G54MAFTX 011415 01/22/2015
Innovative Aftermarket Systems L.P. GCOMTX 121813 02/18/2014
Innovative Aftermarket Systems L.P. GCOMTX 121813 02/18/2014
Innovative Aftermarket Systems L.P. GTMAFTX 072612 09/06/2012
Innovative Aftermarket Systems L.P. GUSPTX 070113 07/02/2013
Innovative Aftermarket Systems L.P. GTMAFTX 042513 04/25/2013
Innovative Aftermarket Systems L.P. GINDTX 111511 03/22/2012
Innovative Aftermarket Systems L.P. GMAFTX 111511 02/27/2012
Innovative Aftermarket Systems L.P. GMTX 111511 12/29/2011
Innovative Aftermarket Systems L.P. GNTX 111511 12/29/2011
Innovative Aftermarket Systems L.P. GRTX 111511 12/29/2011
Innovative Aftermarket Systems L.P. GCTX 111511 11/16/2011
Innovative Aftermarket Systems L.P. GTX 111511 11/16/2011
Janus Administrative Solutions, Inc. PGPF_A2000_TX0913 11/01/2013
Janus Administrative Solutions, Inc. PGPN_A3000_TX0813 08/30/2013
Janus Administrative Solutions, Inc. PGPF_A2000_TX0913 11/01/2013
Jim Moran and Associates, Inc. AGTX (01/12) 01/12/2012
Jim Moran and Associates, Inc. TL2T (01/12) 01/12/2012
Page 8of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedJim Moran and Associates, Inc. TLTX (01/12) 01/12/2012
Jim Moran and Associates, Inc. TXBG (01/12) 01/12/2012
Jim Moran and Associates, Inc. TXGP (01/12) 01/12/2012
Jim Moran and Associates, Inc. TXTF (01/12) 01/12/2012
Jim Moran and Associates, Inc. VGTX (01/12) 01/12/2012
Jim Moran and Associates, Inc. AGTX (01/12/12) 01/13/2012
Jim Moran and Associates, Inc. TL2T (01/12/12) 01/13/2012
Jim Moran and Associates, Inc. TXBG (01/12/12) 01/13/2012
Jim Moran and Associates, Inc. TXGP (01/12/12) 01/13/2012
Jim Moran and Associates, Inc. VGTX (01/12/12) 01/13/2012
Knight Management Insurance Services LLC KMIS GAP TX 201508 09/16/2015
Knight Management Insurance Services LLC KMIS GAP TX 11/2013 B 12/18/2013
Knight Management Insurance Services LLC KMIS GAP TX 11/2013 B 12/18/2013
Knight Management Insurance Services LLC KMIS GAP TX 11/2012 12/21/2012
Lee & Mason Financial Services, Inc. APWAV0113 (TX) 03/07/2013
Lee & Mason Financial Services, Inc. APWAV0613-TX 07/25/2013
Lincoln Automotive Financial Services LI-19971-TX 8/11 10/13/2011
Lobel Financial Corp. Texas Debt Cancellation (GAP) 11/10/2011
Lyndon Property Insurance Company GAP-ADDM2426-CF-TX (10/11) 10/13/2011
Lyndon Property Insurance Company GAP-ADDE2426-CF-TX (10/11) 11/22/2011
Maximus Auto Group, Inc. MAG GAP 150MTX 10/14/2011
Maximus Auto Group, Inc. MAG GAP 125MTX 10/15/2011
Maximus Auto Group, Inc. MAG GAP F150MTX 10/16/2011
Maximus Auto Group, Inc. MAG GAP 125MTX (01/12) 02/23/2012
Maximus Auto Group, Inc. MAG GAP 150MTX (01/12) 02/23/2012
Mechanical Breakdown Protection, Inc. (MBPI) TXFMC (FP2630 1112) 01/03/2013
Mechanical Breakdown Protection, Inc. (MBPI) TXFE12 (FP2632 1112) 01/03/2013
Mechanical Breakdown Protection, Inc. (MBPI) TXFE150 (FP2634 1112) 01/03/2013
Mechanical Breakdown Protection, Inc. (MBPI) TXS120 (FP2636 1112) 01/03/2013
Mechanical Breakdown Protection, Inc. (MBPI) TXS150 (FP2638 1112) 01/03/2013
Mechanical Breakdown Protection, Inc. (MBPI) TXFMCC (FP2628 1112) 01/03/2013
Mechanical Breakdown Protection, Inc. (MBPI) TXFEC120 (FP2631 1112) 01/03/2013
Mechanical Breakdown Protection, Inc. (MBPI) TXFEC150 (FP2633 1112) 01/03/2013
Mechanical Breakdown Protection, Inc. (MBPI) TXSC120 (FP2635 1112) 01/03/2013
Mechanical Breakdown Protection, Inc. (MBPI) TXSC150 (FP2637 1112) 01/03/2013
Mechanical Breakdown Protection, Inc. (MBPI) TXFMCF (FP2629 1112) 01/03/2013
Mercedes-Benz Financial Services USA LLC (c/o Zurich) GDTX1111 (11/11) 10/13/2011
Mercedes-Benz Financial Services, USA LLC GDTX0215 (02/15) 02/16/2015
MIC Property and Casualty Insurance Corporation 150 PRO GAP CSCI FT TX (11-13) - GAP Care Advantage 12/17/2013
Page 9of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date Approved
MIC Property and Casualty Insurance Corporation 150 PRO GAP CSCI FT TX (11-13) - Vehicle One 12/17/2013
MIC Property and Casualty Insurance Corporation 120 PRO GAP TX (3-13) 04/01/2013
MIC Property and Casualty Insurance Corporation 150 PRO GAP TX (03-13) (with GAP Care Advantage Logo) 04/01/2013
MIC Property and Casualty Insurance Corporation 150 PRO GAP TX (03-13) (with Vehicle One logo) 04/01/2013
MIC Property and Casualty Insurance Corporation 150 PRO GAP CSCI FT TX (03-13) (with GAP Care Advantage Logo) 04/01/2013
MIC Property and Casualty Insurance Corporation 150 PRO GAP CSCI FT TX (03-13) (with Vehicle One logo) 04/01/2013
MIC Property and Casualty Insurance Corporation 150 PRO GAP TX (09/11) 10/13/2011
MIC Property and Casualty Insurance Corporation Chry CSCI 150 PRO GAP TX (09/11) 10/13/2011
MIC Property and Casualty Insurance Corporation Chry UWC 150 PRO GAP TX (09/11) 10/13/2011
MIC Property and Casualty Insurance Corporation VI 150 PRO GAP TX (09/11) 10/13/2011
MIC Property and Casualty Insurance Corporation 120 PRO GAP TX (09-11) 10/13/2011
MIC Property and Casualty Insurance Corporation
150 PRO GAP CSCI FT TX (09/11)
(with Vehicle One logo) 12/07/2011
MIC Property and Casualty Insurance Corporation
150 PRO GAP CSCI FT TX (09/11)
(with GAP Care Advantage Logo) 12/07/2011
MPP Co., Inc. MPPOUC GAPAD TX 1011 12/21/2011
Nation Motor Club, Inc. NSD RV GAP TX 4/14 06/18/2014
Nation Motor Club, LLC d/b/a Nation Safe Drivers QT3140216 03/30/2016
Nation Motor Club, LLC d/b/a Nation Safe Drivers TX3140216 03/30/2016
Nation Motor Club, LLC d/b/a Nation Safe Drivers RVGTX0116 02/23/2016
Nation Motor Club, LLC d/b/a Nation Safe Drivers CAM313TX 01/16 01/21/2016
Nation Motor Club, LLC d/b/a Nation Safe Drivers CAM316TX 01/16 01/21/2016
Nation Safe Drivers/NIU AM313TX 04/12 02/07/2013
Nation Safe Drivers/NIU AM314TX 04/12 02/07/2013
Nation Safe Drivers/NIU AM316 04/12 02/07/2013
Nation Safe Drivers/NIU AM313TX 01/12 03/15/2012
Nation Safe Drivers/NIU FP 2567 11/11 03/15/2012
Nation Safe Drivers/NIU FP 2568 11/11 03/15/2012
Nation Safe Drivers/NIU FP 2569 11/11 03/15/2012
National Auto Care Corporation TXNAC150FGAP Rev 5/13 07/02/2013
National Auto Care Corporation TXNAC125NFGAP Rev 5/13 07/02/2013
National Auto Care Corporation (Family First) TX GAP150F001 01/14 03/26/2014
National Auto Care Corporation (Family First) TX GAP125NF002 01/14 03/26/2014
National Auto Lenders, Inc. 21707977v1 0940614 05/09/2013
Norman & Company, Inc. RV GAP TX AIC (11/15) 12/18/2015
Norman & Company, Inc. BHPH 125% TX 10/14/2011
Norman & Company, Inc. FP2555 10-11 10/27/2011
Norman & Company, Inc. FP2556 10-11 10/27/2011
Norman & Company, Inc./Classic RV GAP TX (2/14) 04/14/2014
NWAN, Inc. NI G1109 (2-16) 4/26/2016
NWAN, Inc. NI G1042 (12-15) 01/25/2016
Page 10of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedNWAN, Inc. NI G1041 (12-15) 01/25/2016
NWAN, Inc. NI G1022 (9-15) 11/13/2015
NWAN, Inc. NI G1027 (9-15) 11/13/2015
NWAN, Inc. NI G1033 (9-15) 11/13/2015
NWAN, Inc. NI G1038 (9-15) 11/13/2015
NWAN, Inc. NI G1014 (3-15) V1 0615 07/22/2015
NWAN, Inc. NI G1014 (3-15) 05/15/2015
Old Republic Insured Automotive Services, Inc. GAP06-Waiver150-TX (10/11) 10/15/2011
Old Republic Insured Automotive Services, Inc. GAP06-Waiver125-TX (10/11) 10/14/2011
Old Republic Insured Automotive Services, Inc. GAP06-Waiver125-TX (01/12) 03/02/2012
Old Republic Insured Automotive Services, Inc. GAP06-Waiver150-TX (01/12) 03/02/2012
Old Republic Insured Automotive Services, Inc. GAP06-Waiver150-TX FRD (12/11) 01/26/2012
Old Republic Insured Automotive Services, Inc. GAP06-Waiver150-TX (11/11) 12/19/2011
OwnerGUARD Corporation TX.AFA.AB.LZX.1111 12/04/2011
OwnerGUARD Corporation TX.AFA.B.LZX.1111 12/04/2011
OwnerGUARD Corporation TX.AFA.GB.LZX.1111 12/04/2011
OwnerGUARD Corporation TX.AFA.SB.LZX.1111 12/05/2011
OwnerGUARD Corporation d/b/a Program Adminstrator OwnerGUARD: TX.AFA.0613.01B 03/28/2014
OwnerGUARD Corporation d/b/a Program Adminstrator Accelerate: TX.AFA.0613.06J 03/28/2014
OwnerGUARD Corporation d/b/a Program Adminstrator ProGuard: TX.AFA.0613.05I 03/28/2014
OwnerGUARD Corporation d/b/a Program Adminstrator Diamond Warranty: TX.AFA.0613.08M 03/28/2014
OwnerGUARD Corporation d/b/a Program Adminstrator Ameriplus: TX.AFA.0613.04G 03/28/2014
OwnerGUARD Corporation d/b/a Program Adminstrator GWC Warranty: TX.AFA.0613.03F 03/28/2014
OwnerGUARD Corporation d/b/a Program Adminstrator Spectrum: TX.AFA.0613.02D 03/28/2014
Partners Alliance Corporation FI-150 TX (03/2016) 04/29/2016
Partners Alliance Corporation PAC-150 TX (03/2016) 04/29/2016
Partners Alliance Corporation FI 2000 (150 TX) 01/16 12/18/2015
Partners Alliance Corporation FI 2001 (125 TX) 01/16 12/18/2015
Partners Alliance Corporation PAC 1005 (150 TXT) 05/15 08/07/2015
Partners Alliance Corporation FI 2001 (125 TX) 02/15 04/17/2015
Partners Alliance Corporation FI 2000 (150 TX) 02/15 04/17/2015
Partners Alliance Corporation PAC 2000 (150 TX) 1/15 02/02/2015
Partners Alliance Corporation PAC 2001 (125 TX) 1/15 02/02/2015
Partners Alliance Corporation AMT-FI (TXF) 01/13 06/25/2013
Partners Alliance Corporation AMT-FI (TX125) 01/13 06/25/2013
Partners Alliance Corporation AMT-TX125 (11/12) 03/11/2013
Partners Alliance Corporation AMT-TXF (11/12) 03/11/2013
Partners Alliance Corporation AMT-TX (11/12) 01/03/2013
Page 11of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedPartners Alliance Corporation DIF-FI(TX) 11/12 12/06/2012
Partners Alliance Corporation DIF-FI(TX125) 11/12 12/06/2012
Partners Alliance Corporation DIF-FI(TXF) 11/12 12/06/2012
Partners Alliance Corporation DIF-FI(TXT) 11/12 12/06/2012
Partners Alliance Corporation FP2582 (02/12) TX120 08/21/2012
Partners Alliance Corporation DIF-TXT (3/12) 05/04/2012
Partners Alliance Corporation FP2581 (02/12) TX 150 04/25/2012
Partners Alliance Corporation FP2582 (02/12) TX125 04/25/2012
Partners Alliance Corporation FP2583 (02/12) TXF 04/25/2012
Partners Alliance Corporation PAC125TX 02/12 04/25/2012
Partners Alliance Corporation PAC150FTTX 02/12 04/25/2012
Partners Alliance Corporation PAC150TX 02/12 04/25/2012
Partners Alliance Corporation DIF-TX 10/13/2011
Partners Alliance Corporation DIF-TX 125 10/13/2011
Partners Alliance Corporation DIF-TXF 10/13/2011
Phoenix GAP PGAPF TX 100 12/15 03/21/2016
Phoenix GAP PGAPI TX 100 12/15 03/21/2016
Phoenix GAP PAFG 01/18/2012
Phoenix GAP PAGIN 01/18/2012
Plateau Service Company GAP Waiver TX PR-R 12/18/2015
Plateau Service Company GAP Waiver TX Plan RE 12/18/2015
Plateau Service Company GAP Waiver TX PR-R Plan F (07/15) 08/26/2015
Plateau Service Company GAP Waiver TX Plan RE 12/10/2013
Plateau Service Company GAP Waiver TX PR-R 12/10/2013
Plateau Service Company GAP Waiver TX PR-R Plan F 12/10/2013
Plateau Service Company GAP Waiver TX Plan RE 12/10/2013
Plateau Service Company GAP Waiver TX PR-R 12/10/2013
Plateau Service Company GAP Waiver TX PR-R Plan F 12/10/2013
Power Protect Extended Services, Inc. KIGP-TX rev 1/15 02/20/2015
Preferred Administrators 125-SGW-12-TX 03/21/2012
Preferred Administrators 125-SGW-50-12-TX 03/21/2012
Preferred Administrators 125-SGW-50-BCMX-12-TX 03/21/2012
Preferred Administrators 125-SGW-BCMX-12-TX 03/21/2012
Preferred Administrators 150-SGW-12-TX 03/21/2012
Preferred Administrators 150-SGW-50-12-TX 03/21/2012
Preferred Administrators 150-SGW-50-BCMX-12-TX 03/21/2012
Preferred Administrators 150-SGW-BCMX-12-TX 03/21/2012
Preferred Administrators 125-CW-12-TX 05/11/2012
Preferred Administrators 125-CW-50-12-TX 05/11/2012
Preferred Administrators 125-CW-50-BCMX-12-TX 05/11/2012
Page 12of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedPreferred Administrators 125-CW-BCMX-12-TX 05/11/2012
Preferred Administrators 150-CW-12-TX 05/11/2012
Preferred Administrators 150-CW-50-12-TX 05/11/2012
Preferred Administrators 150-CW-50-BCMX-12-TX 05/11/2012
Preferred Administrators 150-CW-BCMX-12-TX 05/11/2012
Preferred Automobile Credit Co. Ltd. (PACCO) HC# 4845-3309-7744v.3 07/18/2012
Premier Dealer Services, Inc. FC-19971-CL-TX 12/15 04/07/2016
Premier Dealer Services, Inc. AGAP-ULT-TX-TOY (5/15) 08/06/2015
Premier Dealer Services, Inc. AGAP-ULT-TX - TOY (3/15) 04/24/2015
Premier Dealer Services, Inc. AGAP-ULT-TX (1/15) 02/25/2015
Premier Dealer Services, Inc. AGAP-ULT-TX (7/14) 08/26/2014
Premier Dealer Services, Inc. FC-19971-TX 03/14 06/27/2014
Premier Dealer Services, Inc. GEN-19971-TX 03/14 06/27/2014
Premier Dealer Services, Inc. LI-19971-TX 03/14 06/27/2014
Premier Dealer Services, Inc. AGAP-ULT-TX (12/13) 03/18/2014
Premier Dealer Services, Inc. AGAP-ULT-TX (9/13) 02/03/2014
Premier Dealer Services, Inc. AGAP-RV-TX (9/13) 01/22/2014
Premier Dealer Services, Inc. TXRVGAP-01 (6/12) 10/12/2012
Premier Dealer Services, Inc. TXGAPUL-04 (5/12) 06/25/2012
Premier Dealer Services, Inc. TXGAPUL-03 (12/11) 01/25/2012
Premier Dealer Services, Inc. TXGAP-02 (9/11) 10/21/2011
Premier Dealer Services, Inc. TXGAPUL-02 (9/11) 10/21/2011
Prime Acceptance Corp. PAC-1001 WVR (09/15) 11/05/2015
Principal Warranty Corp. PWTXF150-M-001 (06/14) [150PWTXF] 05/23/2014
Principal Warranty Corp. PWTXG125-M-001 (06/14) [125PWTXG] 05/23/2014
Principal Warranty Corp. PWTXG150-M-001 (06/14) [150PWTXG] 05/23/2014
Regional Insurance Services Company, Inc. RISCO125NTX 03/22/2012
Regional Insurance Services Company, Inc. RISCO125STX 03/22/2012
Regional Insurance Services Company, Inc. RISCO150TX 03/22/2012
Regional Insurance Services Company, Inc. RISCO150FFTX 03/22/2012
Regional Insurance Services Company, Inc. TRCOG00150 CH (10/11) TX 01/04/2012
Regional Insurance Services Company, Inc. RISCO125NTX 12/08/2011
Regional Insurance Services Company, Inc. RISCO125STX 12/08/2011
Regional Insurance Services Company, Inc. RISCO150FTTX 12/08/2011
Regional Insurance Services Company, Inc. RISCO150TX 12/08/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FC416 06/07/2012
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FC405_0112 (150GATX) 03/06/2012
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FC406_0112 (125GATX) 03/06/2012
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FA205 (150SGTX) 02/17/2012
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FA205 (GDPETX) 02/17/2012
Page 13of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedReinsurance Associates, Inc. d/b/a Financial GAP Administrator FG108 12/28/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FG109 12/28/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FG110 12/28/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FG111 12/28/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FG112 12/28/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FG113 12/28/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FG114 12/28/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FG115 12/28/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator 125EPTX_FA204 12/02/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator 125GWTX_FA202 12/02/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator 125SGTX_FA206 12/02/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator 150EPTX_FA203 12/02/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator 150GWTX_FA201 12/02/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator 150SGTX_FA205 12/02/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator EFMCTX_FA208 12/02/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FMCTX_FA207 12/02/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator APPTX FC115 11/23/2011
Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FAPPTX FC116 11/23/2011
Royal Administration Services, Inc Royal GAPADD-009 TX Rev. 09-12 11/16/2012
Safe-Guard Products International, LLC MIGP-TX Rev. 3/16 04/27/2016
Safe-Guard Products International, LLC BMGP-TX Rev. 3/16 04/27/2016
Safe-Guard Products International, LLC VRGP-TX Rev. 11/15 01/15/2016
Safe-Guard Products International, LLC ANGP-TX-GEN Rev. 11/15 01/15/2016
Safe-Guard Products International, LLC ANGP-TX Rev. 07/15 09/16/2015
Safe-Guard Products International, LLC PPGP-TX 06/12/2015
Safe-Guard Products International, LLC BEGP-TX 04/01/2015
Safe-Guard Products International, LLC LAGP-TX 04/01/2015
Safe-Guard Products International, LLC PFF2036TX 04/01/2015
Safe-Guard Products International, LLC POGP-TX 03/13/2015
Safe-Guard Products International, LLC QSGP-TX 03/13/2015
Safe-Guard Products International, LLC APRGP-TX Rev. 11/13 01/08/2014
Safe-Guard Products International, LLC APRGP-TX Rev. 8/13 09/10/2013
Safe-Guard Products International, LLC AAGP-TX 09/09/2013
Safe-Guard Products International, LLC AFSGAPTXA0313 02/21/2013
Safe-Guard Products International, LLC HFGAPTX0313 02/21/2013
Safe-Guard Products International, LLC GSRP-TX Rev. 8/12 09/26/2012
Safe-Guard Products International, LLC PPGP-TX Rev 1/13 10/17/2012
Safe-Guard Products International, LLC RSGP-TX Rev. 8/12 09/19/2012
Safe-Guard Products International, LLC
CMGPSET-TX Rev. 06/12
(also shows form number PFF2036TX) 08/24/2012
Page 14of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedSafe-Guard Products International, LLC HYGP-TX Rev. 8/12 07/31/2012
Safe-Guard Products International, LLC KIGP-TX Rev. 8/12 07/31/2012
Safe-Guard Products International, LLC INGPFM-TX 06/14/2012
Safe-Guard Products International, LLC INRGP-TX Rev 02/12 05/29/2012
Safe-Guard Products International, LLC SGRGP-TX Rev 02/12 05/29/2012
Safe-Guard Products International, LLC ANGPFM-TX 12/08/2011
Safe-Guard Products International, LLC ANGP-TX 12/08/2011
Safe-Guard Products International, LLC BMGP-TX 12/08/2011
Safe-Guard Products International, LLC INGP-TX 12/08/2011
Safe-Guard Products International, LLC MIGP-TX 12/08/2011
Safe-Guard Products International, LLC SGGPFM-TX 12/08/2011
Safe-Guard Products International, LLC SGGP-TX 12/08/2011
Service Guard Insurance Agency 125-SGW-50-BCMX13-TX 11/30/2012
Service Guard Insurance Agency 150-CUDL-50-BC-13-TX 11/30/2012
Service Guard Insurance Agency 150-CUDL-50-BCMX-TX 11/30/2012
Service Guard Insurance Agency 150-CUDL-50-MX-13-TX 11/30/2012
Service Guard Insurance Agency 150-CUDL-BC-13-TX 11/30/2012
Service Guard Insurance Agency 150-CUDL-BCMX-13-TX 11/30/2012
Service Guard Insurance Agency 150-CUDL-MX-13-TX 11/30/2012
Service Guard Insurance Agency 150-SGW-50-BCMX-13-TX 11/30/2012
Service Guard Insurance Agency 150-SGW-50-MX-13-TX 11/30/2012
Service Guard Insurance Agency 150-SGW-BC-13-TX 11/30/2012
Service Guard Insurance Agency 150-SGW-BCMX-13-TX 11/30/2012
Service Guard Insurance Agency 150-SGW-MX-13-TX 11/30/2012
Service Guard Insurance Agency 125-CUDL-50-BCMX-13-TX 11/30/2012
Service Guard Insurance Agency 150-SGW-50-BC-13-TX 11/30/2012
Service Guard Insurance Agency 125-SGW-50-BCMX-13-TX 11/30/2012
Service Guard Insurance Agency 150-SGW-BCMX-Toyota-13-TX 12/21/2012
Service Guard Insurance Agency 150-SGW-50-BC-Toyota-13-TX 12/21/2012
Service Guard Insurance Agency 150-SGW-MX-Toyota-13-TX 12/21/2012
Service Guard Insurance Agency 150-SGW-BC-Toyota-13-TX 12/21/2012
Service Guard Insurance Agency 150-SGW-50-BCMX-Toyota-13-TX 12/21/2012
Service Guard Insurance Agency 150-SGW-50-MX-Toyota-13-TX 12/21/2012
Service Guard Insurance Agency 150-SGW-50-Toyota-13-TX 12/21/2012
Service Guard Insurance Agency 150-SGW-Toyota-13-TX 12/21/2012
South Texas Acceptance Corp. FL629477 Q 06/13/2013
Southwest Reinsure, Inc. BIJ-TX-XX-001 02/02/2012
Starr Indemnity & Liability Company 150 CVS GAP TX 02/13 06/14/2013
Starr Indemnity & Liability Company 150 CVS GAP TX0213 TF/FMC 06/14/2013
Stellar Auto Group LLC d/b/a HRS Motors Cars or Regal Captial Credit DCA-1A 07/28/2015
Page 15of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedSummit Administrators, Inc TX Plan RE-Summit 09/09/2014
Summit Administrators, Inc TX PR--R--Summit 09/09/2014
Summit Administrators, Inc TX PR -- R Plan F--Summit 09/09/2014
SWBC RBDTX 05/13 06/14/2013
SWBC SWBCTX150 08/07/2012
SWBC-American National (ANICO) SWBCTX150_2DLQ 10/08/2014
T.A.S.A of KY, Inc. DGA00150 CH (08/13) TX EF 10/09/2013
T.A.S.A of KY, Inc. TGA00125 CH (09/13) EF 11/05/2013
T.A.S.A of KY, Inc. TGA00150 CH (09/13) EF 11/05/2013
T.A.S.A of KY, Inc. SGNB150 (Rev. 11/2012) TX 01/03/2013
T.A.S.A of KY, Inc. SGNB150 (Rev. 1/2012) TX 07/30/2012
T.A.S.A of KY, Inc. DGA00150 CH (10/11) TX 12/02/2011
T.A.S.A of KY, Inc. TGA00125 CH (10/11) TX 12/02/2011
T.A.S.A of KY, Inc. TGA00150 CH (10/11) TX 12/02/2011
T.A.S.A. of KY, Inc. TGA00135 RV (5/15) TX 07/17/2015
T.A.S.A. of KY, Inc. TGA00125 CH (09/13) TX EF 11/05/2013
T.A.S.A. of KY, Inc. TGA00150 CH (09/13) TX EF 11/05/2013
T.A.S.A. of KY, Inc. TGA00125 CH (09/13) TX EF 11/05/2013
T.A.S.A. of KY, Inc. TGA00150 CH (09/13) TX EF 11/05/2013
Texas Car-Mart, Inc. Revision # 103561 (TX) 12/28/2011
The Wildfire Group, LLC TLC/TXRV/0612 10/10/2012
The Wildfire Group, LLC d/b/a Total Loss Coverage Gap TLC/RV125%TX0612 08/07/2012
The Wildfire Group, LLC d/b/a Total Loss Coverage Gap TLC/TX150/1011 11/04/2011
The Wildfire Group, LLC d/b/a Total Loss Coverage Gap TLC/TXNF125/1011 11/04/2011
Toyota Motor Insurance Services, Inc. 111542XE 03/01/2012
Toyota Motor Insurance Services, Inc. 111542 12/01/2011
Toyota Motor Insurance Services, Inc. 111542U 12/01/2011
TT of Flagler, Inc d/b/a Total Warranty Services (TWS) TWS-GAP-004 TX (10/13) 11/20/2013
TT of Flagler, Inc d/b/a Total Warranty Services (TWS) TWS-GAP-005 FM-TX (10/13) 11/20/2013
TT of Flagler, Inc d/b/a Total Warranty Services (TWS) TWS-GAP-005 TFS-TX (10/13) 11/20/2013
TT of Flagler, Inc. d/b/a Total Warranty Services TWS-GAP-004 TX (10/13) 11/20/2013
TT of Flagler, Inc. d/b/a Total Warranty Services TWS-GAP-005 FM-TX (10/13) 11/20/2013
TT of Flagler, Inc. d/b/a Total Warranty Services TWS-GAP-005 TFS-TX (10/13) 11/20/2013
United Auto Credit Corporation UACC Form 511-TX 01/13/2012
United States Warranty Corp. FP2562 11/03/2011
United States Warranty Corp. FP2563 11/03/2011
United States Warranty Corp. USTX 125 11/03/2011
United States Warranty Corp. USTX 150 11/03/2011
United States Warranty Corp. SNTX 150 03/08/2012
Universal Warranty Corporation GAP-150-PRO-DLR-DLPT-TX (10/15) 01/27/2016
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Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedUniversal Warranty Corporation GAP-150-PRO-DLR-DLPF-TX (10/14) 06/17/2015
Universal Warranty Corporation GAP-120-PRO-DLR-TX (10/14) 01/16/2015
Universal Warranty Corporation GAP-150-PRO-DLR-TX (10/14) 01/16/2015
Universal Warranty Corporation GCA-150 PRO UWC FT TX (01/15) 12/17/2014
Universal Warranty Corporation GCA-120 PRO TX (04/14) 06/18/2014
Universal Warranty Corporation GCA-120 PRO UWC TX (05/14) 06/18/2014
Universal Warranty Corporation GCA-150 PRO CSCI FT TX (04/14) 06/18/2014
Universal Warranty Corporation GCA-150 PRO TX (04/14) 06/18/2014
Universal Warranty Corporation GCA-150 PRO UWC FT TX (05/14) 06/18/2014
Universal Warranty Corporation GCA-150 PRO UWC TX (05/14) 06/18/2014
Universal Warranty Corporation V1-150 PRO CSCI FT TX (04/14) 06/18/2014
Universal Warranty Corporation V1-150 PRO TX (04/14) 06/18/2014
Universal Warranty Corporation V1-150 PRO UWC FT TX (05/14) 06/18/2014
Universal Warranty Corporation V1-150 PRO UWC TX (05/14) 06/18/2014
Vantage Warranty, Inc GTX_082312 08/24/2012
Vantage Warranty, Inc GTX_082312 12/12/2012
Vantage Warranty, Inc. dba RoadVantage GTX_072214 08/06/2014
Vantage Warranty, Inc. dba RoadVantage GTX120_072214 08/06/2014
Vantage Warranty, Inc. dba RoadVantage GTX125_072214 08/06/2014
Vehicle Protection Direct VPD150res-1113 09/25/2015
Vehicle Protection Direct VPD125/150res-0214 07/29/2015
Vehicle Protection Direct VPD125/150res-0214 04/03/2014
Vehicle Protection Direct VPD125/150res-0214 04/03/0214
Vehicle Protection Services vpdLegaltexas 125 9-13 10/18/2013
Vehicle Protection Services vpdLegaltexas 125 9-13 10/18/2013
Vehicle Protection Services LLC vpd 150 ndl 6-14 09/30/2014
Vehicle Protection Services LLC VPD150res-1113 12/19/2013
Vehicle Protection Services LLC VPD150res-1113 12/19/2013
Veros Credit, LLC TX Rev. 5/2014 (originally submitted as TX Rev. 3/2014) 05/13/2014
Veros Credit, LLC TX Rev. 5/2014 05/13/2014
Virginia Surety Company, Inc. GAP-91 TX (R 08/11) 11/17/2011
Virginia Surety Company, Inc. GAP-107 TX (01/12) 03/09/2012
Virginia Surety Company, Inc. GAP-107 TFS TX (01/12) 04/12/2012
Warrantech Automotive, Inc. 11MGAP0412_TX 06/10/2013
Warrantech Automotive, Inc. 11WGAP0812_TX 150 06/10/2013
Warrantech Automotive, Inc. 11WGAP0812_TX 125 06/10/2013
Warrantech Automotive, Inc. 11WGAP0812_TX 120 06/10/2013
Warrantech Automotive, Inc. 11CGAP1014_TX_FMCC-150 05/11/2015
Warrantech Automptive, Inc. 11CGAP1014_TX_-150 05/21/2015
Western Diversified Services, Inc. GAP-ADDM2429-NCF-NON TUC-TX (3/16) 11/30/2015
Page 17of 18
Debt Cancellation Agreement Forms Approved by the OCCC
under Chapter 348, Subchapter G, Texas Finance Code
Approved as of: 5/4/2016
Name Form Number Date ApprovedWestern Diversified Services, Inc. GAP-ADDM2429-NON TUC-TY-TX (3/16) 11/30/2015
Western Diversified Services, Inc. GAP-ADDM2429-TUC-TX (3/16) 11/30/2015
Western Diversified Services, Inc. GAP-ADDM2429-NCF-TUC-TX (3/16) 11/30/2015
Western Diversified Services, Inc. GAP-ADDM2429-TUC-TY-TX (3/16) 11/30/2015
Western Diversified Services, Inc. GAP-ADDM2429-NON TUC-TX (3/16) 11/30/2015
Western Funding Incorporated WFI DCA TX 1-2013 02/26/2013
Western General Insurance Company d/b/a Western General Automobile Insurance Company WGIC-816 TX (REV. 01/12) 12/21/2011
WNC Insurance Services Inc. ABCDEI-OC 10/21/2011
Zurich V4103LL (11/11) 10/13/2011
Zurich V41040LL (11/11) 10/13/2011
Zurich V41050LL (11/11) 10/13/2011
Zurich V41030LL (11/11) 10/13/2011
Zurich d/b/a Universal Underwriters Serivce Corporation V44580HQ (08/15) 08/06/2015
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