Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018 Name Form Number Date Approved Advanced Protection Products International, Inc. APPI GAP06-Waiver150 (01-17) 02/24/2017 Aeverex 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 Aftercare, Inc. AG03QTXA R1 6 7 2018 06/14/2018 Allied Solutions, LLC TIDEWATER TX 90% PRORATA 6/2016 07/21/2016 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. FP2573 0212 03/06/2012 American Auto Guardian, Inc. FP2574 0212 03/06/2012 American Auto Guardian, Inc. FP2575 0212 03/06/2012 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. AAGI-ANICO-GAP-CX-TX (01/17) 01/04/2017 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 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 (First Dealer Resources, LLC) FP2420 0413 11/19/2013 American Colonial Administration, LLC (First Dealer Resources, LLC) FP2423 0413 11/19/2013 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 Financial & Automotive Services, Inc. AFAS-0106 12/22/2011 American Financial & Automotive Services, Inc. AFAS-0107 12/22/2011 Page 1 of 27
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OCCC Approved DCA forms · 2018-12-01 · Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018 Name Form Number Date Approved American Security Insurance
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Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved Advanced Protection Products International, Inc. APPI GAP06-Waiver150 (01-17) 02/24/2017 Aeverex 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 Aftercare, Inc. AG03QTXA R1 6 7 2018 06/14/2018 Allied Solutions, LLC TIDEWATER TX 90% PRORATA 6/2016 07/21/2016 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. FP2573 0212 03/06/2012 American Auto Guardian, Inc. FP2574 0212 03/06/2012 American Auto Guardian, Inc. FP2575 0212 03/06/2012 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. AAGI-ANICO-GAP-CX-TX (01/17) 01/04/2017 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 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 (First Dealer Resources, LLC) FP2420 0413 11/19/2013 American Colonial Administration, LLC (First Dealer Resources, LLC) FP2423 0413 11/19/2013 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 Financial & Automotive Services, Inc. AFAS-0106 12/22/2011 American Financial & Automotive Services, Inc. AFAS-0107 12/22/2011
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Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved American Financial & Automotive Services, Inc. AFAS-0108 12/22/2011 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 American Financial & Automotive Services, Inc. AFAS-0106 rev (01/12) 03/06/2012 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 6/13 09/05/2013 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 Financial Warranty Corporation MTGAP-0107 Rev. 1/16 01/08/2016 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-0109 REV. 7/16 09/22/2016 American Financial Warranty Corporation MTGAPC 0150 TX (1018) 11/16/2018 American Financial Warranty Corporation MTGAPC FMC 0150 TX (1018) 11/16/2018 American Financial Warranty Corporation MTGAP 0150 TX (07/17) 11/10/2017 American Financial Warranty Corporation MTGAP 0125 TX (07/17) 11/10/2017 American Financial Warranty Corporation MTGAPC 0150 TX (07/17) 11/10/2017 American Financial Warranty Corporation MTGAPC FMC 0150 TX (0418) 05/25/2018 American Guardian Warranty Services AG-VSC-RGW (05.12) TX 08/10/2012 American Guardian Warranty Services AG Base GW VS (04.13) TX 06/28/2013 American Guardian Warranty Services, Inc. AG Base GW VS TX_11.15 11/20/2015 American Guardian Warranty Services, Inc. AG Base GW VS TX FMC_02.16 03/28/2016 American Guardian Warranty Services, Inc. 01_02_GAP_17_B_TX 10/25/2017 American Guardian Warranty Services, Inc. 01_02_GAP_17_B_TX_TFS 12/2017 02/02/2018 American Guardian Warranty Services, Inc. 1_02_RVGAP_18_B_TX 04/2018 07/11/2018 American Guardian Warranty Services, Inc. 01_02_GAP_18_B_TX 7/2018 08/17/2018 American Guardian Warranty Services, Inc. 01_02_GAP_18_B_TX_TFS 07/2018 08/17/2018 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 American National Administrators, Inc. AT125NTX 01/17 03/03/2017 American National Administrators, Inc. AT125TX 01/17 03/03/2017 American National Administrators, Inc. AT150FTTX 01/17 03/03/2017 American National Administrators, Inc. AT150TX 01/17 03/03/2017 American Security Insruance Company RVGP0003W-0917 TX 11/10/2017 American Security Insruance Company AUGP0003W-0917 TX 11/10/2017 American Security Insurance Company (United Service Protection Corp.) AUGP0003W-0516 08/11/2016
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Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved American Security Insurance Company (United Service Protection Corp.) RVGP0003W-0516 08/11/2016 AMT Warranty Corp. 11GGAP0513_TX_150 05/23/2013 AMT Warranty Corp. 11GGCC0115_150_TX 05/22/2015 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-TX0714 09/03/2014 Apex Protection, Inc. GAP-TX0714-REV A 10/22/2014 Apex Protection, Inc. GAP-TX1214-TFS REV A 04/29/2015 Apex Protection, Inc. FAP-TX0918 11/28/2018 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 Acceptance Corporation AAC-GAP-TX (05/16) 05/10/2016 Automobile Acceptance Corporation (Fortegra) AAC-GAP-TX (5/16) 12/06/2016 Automobile Protection Corporation 8030332 (002) 11/18 11/14/2018 Automobile Protection Corporation (APCO) 8030124 (007) 10/11 10/13/2011 Automobile Protection Corporation (APCO) 8030123 (002) 10/11 11/22/2011 Automobile Protection Corporation (APCO) 8030126 (004) 03/12 03/15/2012 Automobile Protection Corporation (APCO) 8030122 (007) 10/11 10/13/2011 Automobile Protection Corporation dba Easycare 8030251 (002) 10/17 11/03/2017 Automobile Protection Corporation dba Easycare 8030252 (002) 03/18 TEXAS 03/29/2018 Automobile Protection Corporation dba Easycare 8030270 (001) 7/18 07/30/2018 Automobile Protection Corporation dba Easycare 8030272 (001) 7/18 07/30/2018 Automobile Protection Corporation dba Easycare 8030329 (003) 09/18 09/30/2018 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 Automotive Warranty Services, Inc. GAP-214 TX (04/16) 07/01/2016 Automotive Warranty Services, Inc. GAP-215 TX (04/16) 07/01/2016 Automotive Warranty Services, Inc. GAP-216 TX (05/16) 07/01/2016 Automotive Warranty Services, Inc. GAP-107 TX-10K (11/16) 03/13/2017 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 150% TX 01/11/2012 CALL GAP Ltd. d/b/a Gap Insurance Services Extreme GAP ETXF150-M-001 07-11 03/09/2012 CALL GAP Ltd. d/b/a Gap Insurance Services Extreme GAP ETXG125-M-001 07-11 03/09/2012 CALL GAP Ltd. d/b/a Gap Insurance Services Extreme GAP ETXG150-M-001 07-11 03/09/2012 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
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Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved Caregard Warranty Services TX346 12/20/2011 Caregard Warranty Services TX733 12/20/2011 CareGard Warranty Services, Inc. TX 334 12/16 04/13/2017 CareGard Warranty Services, Inc. TX 346 12/16 04/13/2017 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 Challenge Financial Services, Inc. d/b/a CF Services, Inc. 1004-100CF-TX Rev. 12/2015 05/25/2016 CIG Financial LLC CIG DCA FORM NO. TXV092017: Supercedes all previous versions 10/04/2017 CIG Financial, LLC CIG DCA VER 092015 09/11/2015 CNA National Warranty Corporation 6932 (10/11) 11/21/2011 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 8902 (11/15) 10/21/2016 Comprehensive Auto Resources Company (CARco) GTXF-150 (07-16) 01/25/2017 Comprehensive Auto Resources Company (CARco) TX125 [01/18] 04/09/2018 Comprehensive Auto Resources Company (CARco) TX125 Rev. 07/18 09/20/2018 Comprehensive Auto Resources Company (CARco) GTX125 Rev. 07/18 09/20/2018 Comprehensive Auto Resources Company (CARco) TX125-96 Rev. 07/18 09/20/2018 Comprehensive Auto Resources Company (CARco) TX150 Rev. 07/18 09/20/2018 Comprehensive Auto Resources Company (CARco) GTX150 Rev. 07/18 09/20/2018 Comprehensive Auto Resources Company (CARco) TX150-96 Rev. 07/18 09/20/2018 Comprehensive Auto Resources Company (CARco) GTX150-96 Rev. 07/18 09/20/2018 Comprehensive Auto Resources Company (CARco) GAP WAIVER CRO-TX Rev. 07/18 09/20/2018 Comprehensive Auto Resources Company (CARco) GTX125-96 Rev. 07/18 09/20/2018 Comprehensive Auto Resources Company, Inc. (CARco) CARTX125-M-001 (7/11) 10/13/2011 Comprehensive Auto Resources Company, Inc. (CARco) CARTX150-M-001 (7/11) 10/14/2011 Comprehensive Auto Resources Company, Inc. (CARco) CARTX150NF-M-001 (7/11) 10/15/2011 Comprehensive Auto Resources Company, Inc. (CARco) RV-TX Rev. 10/12 12/03/2012 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) 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) GRCARTX (05/14) 06/30/2014 Comprehensive Auto Resources Company, Inc. (CARco) CRO-TX (09-14) 11/14/2014 Comprehensive Auto Resources Company, Inc. (CARco) TXF-150 (07/16) 09/28/2016 CornerStone United Inc. CSAGBTX125-M-002 (10/11) 10/13/2011 CornerStone United Inc. CSAGBTX150-M-002 (10/11) 10/13/2011
Page 4 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved CornerStone United Inc. CSAGFTX150-M-002 (10/11) 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. CSAGTX150-N-001 (08/16) 10/14/2016 CornerStone United, Inc. CSAGFTX150-N-001 (08/16) 10/14/2016 Creditor's Captive Formation Corporation V.2.2 TX 04/19/2012 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. 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. 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. ETXT150-M-001 (3/12) 04/30/2012 D&P Holdings, Inc. STTX150-M-001 (3/12) 04/30/2012 D&P Holdings, Inc. EXTX150-WESC-001 rev (05/13) 05/22/2013 D&P Holdings, Inc. GGTX150-WESC-001 rev (05/13) 05/22/2013 D&P Holdings, Inc. EFTX150-WESC-001 07/26/2013 D&P Holdings, Inc. GFTX150-WESC-001 07/26/2013 D&P Holdings, Inc. d/b/a Auto Trac System ETXF150-N-001 [08/16] 10/21/2016 D&P Holdings, Inc. d/b/a Auto Trac System ETXG-150-N-001 [08/16] 10/21/2016 D&P Holdings, Inc. d/b/a Auto Trac System GTXF-150-N-001 [08/16] 10/21/2016 D&P Holdings, Inc. d/b/a Auto Trac System GTXG150-N-001 [08/16] 10/21/2016 D&P Holdings, Inc. d/b/a Auto Trac System SGTXF150-N-001 [08/16] 10/21/2016 D&P Holdings, Inc. d/b/a Auto Trac System SGTXG150-N-001 [08/16] 10/21/2016 D&P Holdings, Inc. d/b/a Auto Trac System ATXF150-N-001 [08/16] 10/21/2016 D&P Holdings, Inc. d/b/a Auto Trac System ATXG150-N-001 [08/16] 10/21/2016 D&P Holdings, Inc. d/b/a Auto Trac System ETXBW150-N001 [02/17] 04/07/2017 D&P Holdings, Inc. d/b/a Auto Trac System ETXG125-N-001 09/08/2017 D&P Holdings, Inc. d/b/a Auto Trac System, d/b/a Diversified Insurance Facilities ETXF150-R-001 04/15 05/26/2015
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Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved 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 D&P Holdings, Inc. dba Auto Trac System KTXMP125-N-001 (03/18) 03/19/2018 D&P Holdings, Inc. dba Auto Trac System PTXMP125-N-001 (03/18) 03/19/2018 D&P Holdings, Inc. dba Auto Trac System ETXT150-N-001 08/18 10/02/2018 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 DriveTime Car Sales Company, LLC GAP (DT-TX) 08-2016 11/08/2016 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 10/15/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2502 1011 10/16/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2503 1011 10/17/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2504 1011 10/18/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2505 1011 10/19/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2506 1011 10/20/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2507 1011 10/21/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2508 1011 10/22/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2509 1011 10/23/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2510 1011 10/24/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2511 1011 10/25/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2512 1011 10/25/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2513 1011 10/27/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2514 1011 10/28/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2515 1011 10/29/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2516 1011 10/30/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2517 1011 10/30/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2518 1011 11/01/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2519 1011 11/02/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2520 1011 11/03/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2521 1011 11/04/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2522 1011 11/05/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2523 1011 11/06/2011
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Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2524 1011 11/07/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2525 1011 11/08/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2526 1011 11/09/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2527 1011 11/10/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2528 1011 11/11/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2529 1011 11/12/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2530 1011 11/13/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2531 1011 11/14/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2533 1011 11/15/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2534 1011 11/16/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2535 1011 11/17/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2536 1011 11/18/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2537 1011 11/19/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2538 1011 11/20/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2539 1011 11/21/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2540 1011 11/22/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2541 1011 11/23/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2542 1011 11/24/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2543 1011 11/25/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2544 1011 11/26/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2545 1011 11/27/2011 E.R.J. Insurance Group d/b/a American Heritage Insurance Services 2546 1011 11/28/2011 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 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 FP2874 0316 04/07/2016 E.R.J. Insurance Group d/b/a American Heritage Insurance Services FP2801 0316 07/05/2016 E.R.J. Insurance Group d/b/a American Heritage Insurance Services FP2802 0316 07/05/2016 E.R.J. Insurance Group d/b/a American Heritage Insurance Services FP2803 0316 07/05/2016 E.R.J. Insurance Group d/b/a American Heritage Insurance Services FP2804 0316 07/05/2016 Enterprise Financial Group GAP WAIVER 125500 (0518) – TX 06/29/2018 Enterprise Financial Group, EFG Companies GAP WAIVER VS (0117) - TX 03/31/2017 Enterprise Financial Group, EFG Companies GAP WAIVER VS (0117) - TX FMCC 03/31/2017 Enterprise Financial Group, EFG Companies GAP-WAIVER VS MS (0917) - TX 10/17/2017 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
Page 7 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved 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 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% PRB TX (08/12) 09/25/2012 Enterprise Financial Group, Inc. GAP-WAIVER TX (0914) RL 12/12/2014 Enterprise Financial Group, Inc. GAP WAIVER VS - 125% (0818) TX 09/20/2018 Enterprise Financial Group, Inc. GAP WAIVER VS 125% - TX FMCC 09/20/2018 ERJ Insurance Group dba American Heritage Insurance Services FP2851 0917-H 10/04/2017 Ethos Group, Inc. 101010-61000-TX-20120817 08/17/2012 Ethos Group, Inc. 101010-61000-TX-FD-20120816 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. GPW 0152-0929B 05/27/2016 Ethos Group, Inc. GPWR-TX-1708 Rev. 171006 10/12/2017 Ethos Group, Inc. GPWRC-TX-1708 Rev. 171006 10/12/2017 Ethos Group, Inc. GPWRC-TXTY-1708 Rev. 171129 12/07/2017 Ethos Group, Inc. GPWR-TXTY-1708 Rev. 171129 12/07/2017 Ethos Group, Inc. GPWRC-TX-1708C 01/12/2018 Ethos Group, Inc. GPWR-TX-1708C 01/12/2018 Ethos Group, Inc. GPWRC-TXTY-1708C 01/12/2018 Ethos Group, Inc. GPWR-TXTY-1708C 01/12/2018 Ethos Group, Inc. GPWRC-TXTY-1708 Rev. 180409 05/17/2018 Ethos Group, Inc. GPWR-TXTY-1708 Rev. 180409 05/17/2018 Ethos Group, Inc. TXGAP-1810-CI 11/02/2018 Ethos Group, Inc. TXGAP-1810-CI-C 11/02/2018 Ethos Group, Inc. TXGAP-1810-TI 11/07/2018 Ethos Group, Inc. TXGAP-1810-TI-C 11/07/2018 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 (03/16) 12/14/2016 Express Systems, Inc. GAP-VS-TX RV (03/16) 12/14/2016 Express Systems, Inc. GAP-VS-FMCC-TX (3/16) 12/14/2016
Page 8 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved Express Systems, Inc. GAP-VS-TFS-TX (3/16) 12/14/2016 Express Systems, Inc. GAP-PS-VS-TX-125 (6/17) 08/22/2017 Express Systems, Inc. GAP-TX-VG (8/18) 10/26/2018 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 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-TX-FMCC (3/12) 06/14/2012 Express Systems, Inc. GAP-VS-TX-TFS (3/12) 09/19/2012 Express Systems, Inc. GAP-VS-TX-TFS (7/14) 08/21/2014 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 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 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 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 FF203 11/16 (also numbered as GWRVTX) 12/28/2016 Financial Gap Administrator LLC FF207 11/16 (also numbered as EPRVTX) 12/28/2016 Financial Gap Administrator LLC FF206 11/16 (also numbered as SGRVTX) 12/28/2016 Financial Gap Administrator LLC FF212 09/17 08/22/2017 Financial Gap Administrator LLC FF214 09/17 10/25/2017 Financial Gap Administrator LLC FF218 11/17 02/15/2018 Financial Gap Administrator LLC FG114 02/18 05/07/2018 Financial Gap Administrator LLC FF221 11/17 05/07/2018
Page 9 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved Financial Gap Administrator LLC FF224 06/18 08/30/2018 Financial Gap Administrator LLC FF226 07/18 08/30/2018 Financial Gap Administrator LLC FG108 06/18 09/14/2018 Financial Gap Administrator LLC FG109 06/18 09/14/2018 Financial Gap Administrator LLC FG110 06/18 09/14/2018 Financial Gap Administrator LLC FG111 06/18 09/14/2018 Financial Gap Administrator LLC FG304 06/18 10/02/2018 Financial Gap Administrator LLC FG305 06/18 10/02/2018 Financial Gap Administrator LLC FG309 06/18 10/02/2018 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 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) 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) 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 FG162 1/16 03/01/2016 Financial Gap Administrator, LLC FG163 1/16 03/01/2016 Financial Gap Administrator, LLC FG191 09/18 10/26/2018 Financial Gap Administrator, LLC FF226 07/18 11/08/2018 Financial Gap Administrator, LLC FG193 09/18 11/08/2018 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 FP2423 0413 06/12/2013 First Dealer Resources, LLC FP2419 0413 06/12/2013 First Dealer Resources, LLC FP2580 0413 06/12/2013 First Dealer Resources, LLC FP24200413 11/19/2013 First Dealer Resources, LLC FP2423 0413 11/19/2013 Ford Motor Credit Company FC-19971-TX 8/11 10/13/2011 Foresight Services Group GAP-FGTX-F-ADDM 0714 09/10/2014 Foresight Services Group GAP-FGTX-ADDM 0714 09/10/2014 ForeSight Services Group, Inc GAP- FGTX125- ADDM 0218 04/10/2018
Page 10 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved ForeSight Services Group, Inc GAP- FGTX- ADDM 0218 04/10/2018 Foresight Services Group, Inc. GAP-FGTX-T-ADDM 0615 06/17/2015 Foresight Services Group, Inc. GAP-FGTX-T-ADDM 0616 09/18/2016 Fortega Financial Corp. FG125 GAP-TX 09/30/2014 Fortega Financial Corp. FG150 GAP-TX 09/30/2014 Fortegra (LOTSolutions, Inc) FG150FMC-TX 08/18 09/30/2018 Frost Financial Services, Inc. GCTXRE0312 04/26/2012 Frost Financial Services, Inc. GCTXRE0917 09/08/2017 Golden Plains Insurance Agency, LLC GPTXv.10 05/27/2016 GS Administrators, Inc. GPWTX1011 11/15/2011 GS Administrators, Inc. GPWTX0212 06/07/2012 GS Administrators, Inc. GPWTXAN0212 06/07/2012 GS Administrators, Inc. GPWTXF1017 12/14/2017 GS Administrators, Inc. GPWTX1017 12/14/2017 GS Administrators, Inc. GPWTXF1217 02/01/2018 GS Administrators, Inc. GPWTX1217 02/01/2018 HUB Financial Services HUB Yamaha TX-R 130 08242017 08/16/2018 HUB Financial Services HUB Yamaha TX-R 140 08242017 08/16/2018 HUB Financial Services 06282017RPMRTX-120 08/16/2018 HUB Financial Services 06282017RPMRTX-150 08/16/2018 HUB Financial Services HUB GAP Yamaha TX-R 06282017 08/24/2017 HUB Financial Services STK# 06282017RPMRTX-120 08/24/2017 HUB Financial Services STK# 06282017RPMRTX-125 08/24/2017 HUB Financial Services STK# 06282017RPMRTX-150 08/24/2017 HUB Financial Services HUB Yamaha TX-R 120 08242017 09/27/2017 HUB Financial Services HUB Yamaha TX-R 130 08242017 09/27/2017 Hundai Protection Plan, Inc. GEGP-TX Rev. 6/16 06/03/2016 Hyundai Protection Plan, Inc HYGP-TX rev 1/13 10/18/2012 Hyundai Protection Plan, Inc. HYGP-TX rev 4/15 02/20/2015 Hyundai Protection Plan, Inc. HYGP-TX Rev 10/17 08/02/2017 Hyundai Protection Plan, Inc. GECP-TX Rev 9/17 08/02/2017 Hyundai Protection Plan, Inc./Safeguard HYGP-TX Rev 9/17 05/18/2017 Independent Dealer Group, Inc. SMART-TRUGAP 6-17 11/08/2017 Independent Dealer Group, Inc. SMART-TRUGAP TX FMC NON-COMM 1-18 04/09/2018 Innovative Aftermarket Systems L.P. GCTX 111511 11/16/2011 Innovative Aftermarket Systems L.P. GTX 111511 11/16/2011 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. GMAFTX 111511 02/27/2012
Page 11 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved Innovative Aftermarket Systems L.P. GINDTX 111511 03/22/2012 Innovative Aftermarket Systems L.P. GTMAFTX 072612 09/06/2012 Innovative Aftermarket Systems L.P. GTMAFTX 042513 04/25/2013 Innovative Aftermarket Systems L.P. GUSPTX 070113 07/02/2013 Innovative Aftermarket Systems L.P. GCOMTX 121813 02/18/2014 Innovative Aftermarket Systems L.P. G54MAFTX 011415 01/22/2015 Innovative Aftermarket Systems L.P. GLTX 041015 04/15/2015 Innovative Aftermarket Systems L.P. AR2572 0415 07/16/2015 Innovative Aftermarket Systems L.P. AR2573 0415 07/16/2015 Innovative Aftermarket Systems LP PS1316 1116 TX 11/10/2017 Innovative Aftermarket Systems, L.P. FP2838 1015 02/23/2016 Innovative Aftermarket Systems, L.P. FP2840 1015 03/03/2016 Interstate National Dealer Services, Inc. IG25-904 TX (4/18) 07/27/2018 Interstate National Dealer Services, Inc. IG50-904 TX (4/18) 07/27/2018 Interstate National Dealer Services, Inc. IG50-904 TX (2/17) 04/07/2017 Interstate National Dealer Services, Inc. IG25-904 TX (2/17) 04/07/2017 Janus Administrative Solutions, Inc. PGPN_A3000_TX0813 08/30/2013 Janus Administrative Solutions, Inc. PGPF_A2000_TX0913 11/01/2013 Jim Moran & Associates, Inc. F-NFTP (01/17) TTFP (01/17) 05/31/2017 Jim Moran & Associates, Inc. F-NTXP (01/17) TTPP (01/17) 05/31/2017 Jim Moran & Associates, Inc. F-NTXP (01/17) TTX2 (01/17) 05/31/2017 Jim Moran & Associates, Inc. F-NTXP (01/17) TTX5 (01/17) 05/31/2017 Jim Moran & Associates, Inc. F-NFTP (01/17) TTXF (01/17) 05/31/2017 Jim Moran & Associates, Inc. F-NTXP (01/17) TTXP (01/17) 05/31/2017 Jim Moran & Associates, Inc. F-NTXP (01/17) VLTX (01/17) 05/31/2017 Jim Moran & Associates, Inc. F-NTXP (01/17) VTXL (01/17) 05/31/2017 Jim Moran & Associates, Inc. F-NTXP (01/18) ▼ TTX2 (01/18) 11/20/2017 Jim Moran & Associates, Inc. F-NTXP (01/18) ▼ TTX2 (12/17) 11/20/2017 Jim Moran & Associates, Inc. F-NTXP (01/18) ▼ TTX5 (01/18) 11/20/2017 Jim Moran & Associates, Inc. F-NTXP (01/18) ▼ TTX5 (12/17) 11/20/2017 Jim Moran & Associates, Inc. F-NTXP (01/18) ▼ VLTX (01/18) 11/20/2017 Jim Moran & Associates, Inc. F-NTXP (01/18) ▼ VLTX (12/17) 11/20/2017 Jim Moran and Associates, Inc. AGTX (01/12) 01/12/2012 Jim Moran and Associates, Inc. TL2T (01/12) 01/12/2012 Jim 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
Page 12 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved 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 11/2012 12/21/2012 Knight Management Insurance Services LLC KMIS GAP TX 11/2013 B 12/18/2013 Knight Management Insurance Services LLC KMIS GAP TX 201508 09/16/2015 Kornerstone Administrative Services, LLC KAS G7 (04-16) 05/13/2016 Kornerstone Administrative Services, LLC KAS G8 (04-16) 05/13/2016 Kornerstone Administrative Services, LLC KAS G9 (04-16) 05/13/2016 Kornerstone Administrative Services, LLC KAS G8 (06/2016) 07/29/2016 Kornerstone Administrative Services, LLC KAS G9 (07/2016) 09/09/2016 Kornerstone Administrative Services, LLC KAS G7 (07/2016) 09/09/2016 Kornerstone Administrative Services, LLC KAS G8 (11/2016) 11/21/2016 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 (Vehicle Protection Inc ) CPGO204D17 4/2017 edition 08/24/2017 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 TX (09/11) 10/13/2011
Page 13 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved 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 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 CSCI FT TX (11-13) - GAP Care Advantage 12/17/2013 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 150 PRO GAP CSCI FT TX (09/11) 12/07/2011 MIC Property and Casualty Insurance Corporation 150 PRO GAP CSCI FT TX (09/11) 12/07/2011 MILCO, Inc. dba PowerGuard International PGTX125 Rev. 01/2018 04/09/2018 MILCO, Inc. dba PowerGuard International PGTX150 Rev. 01/2018 04/09/2018 MPP Co. Inc MPPOUC GAPAD FMCTX 517 07/05/2017 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 P6TX0118 01/19/2018 Nation Motor Club, LLC P7TX0118 01/19/2018 Nation Motor Club, LLC 313T0418 05/22/2018 Nation Motor Club, LLC 314T0418 05/22/2018 Nation Motor Club, LLC 316T0418 05/22/2018 Nation Motor Club, LLC 28T30818 10/09/2018 Nation Motor Club, LLC 28T40818 10/09/2018 Nation Motor Club, LLC 28T60818 10/09/2018 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 Motor Club, LLC d/b/a Nation Safe Drivers RVGTX0116 02/23/2016 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 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 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 National Auto Care (Family First Dealer Services) CUDL TX GAPCC 150F001 01/17 12/16/2016 National Auto Care (Family First Dealer Services) TX GAPCC 150F001 01/17 12/16/2016
Page 14 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved National Auto Care (Family First Dealer Services) VERO TX GAPCC150F001 01/17 12/16/2016 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 VEROW1015NFGAP96TX 01/16 08/23/2016 National Auto Care Corporation VEROW1014FGAP96TX 01/16 08/23/2016 National Auto Care Corporation TX SGIGAPCC150F001 05/17 06/30/2017 National Auto Care Corporation TX SGIGAP150F001 05/17 06/30/2017 National Auto Care Corporation TX SGIGAPCC125NF002 08/17 10/02/2017 National Auto Care Corporation TX SGIGAP125NF002 08/17 10/02/2017 National Auto Care Corporation NACW150FGAP84TX 01/18 03/22/2018 National Auto Care Corporation CRESC2 GAP125F001 TX 12/16 03/22/2018 National Auto Care Corporation TX GAPCC150F001SF 11/17 03/22/2018 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 National Warranty Corp./Interstate National Dealer Services, Inc. NG50-904 TX (6/17) 08/18/2017 National Warranty Corp./Interstate National Dealer Services, Inc. NG25-904 TX (6/17) 08/18/2017 Norman & Company, Inc Signature GAP TX WIC 125% 10/15 05/13/2016 Norman & Company, Inc Signature GAP TX WIC 150% 10/15 05/13/2016 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. RV GAP TX AIC (11/15) 12/18/2015 Norman & Company, Inc. dba ClassicTrak Marine GAP (01/18) 03/01/2018 Norman & Company, Inc. dba ClassicTrak Marine GAP SAT TX (01/18) 03/01/2018 Norman & Company, Inc. dba ClassicTrak GAP COMPLETE TX 125% (3/18) 04/12/2018 Norman & Company, Inc. dba ClassicTrak GAP COMPLETE TX 150% (3/18) 04/12/2018 Norman & Company, Inc./Classic RV GAP TX (2/14) 04/14/2014 Norman and Company, Inc. MOTO GAP TX LS 125% (07/17) 09/06/2017 Norman and Company, Inc. MOTO GAP TX LS 150% (07/17) 09/06/2017 NWAN, Inc. NI G1014 (3-15) 05/15/2015 NWAN, Inc. NI G1014 (3-15) V1 0615 07/22/2015 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 G1042 (12-15) 01/25/2016 NWAN, Inc. NI G1041 (12-15) 01/25/2016 NWAN, Inc. NI G1041 (04-16) 01/25/2016 NWAN, Inc. NI G1109 (2-16) 04/26/2016
Page 15 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved NWAN, Inc. NI G1042 (04-16) 05/18/2016 NWAN, Inc. NI G1123 (04-16) 06/10/2016 NWAN, Inc. NI G1124 (04-16) 06/10/2016 NWAN, INC. NI G1134 (1-17) 01/17/2017 NWAN, INC. NI G1139 (1-17) 01/17/2017 NWAN, INC. NI G1123 (1-17) 02/24/2017 NWAN, INC. NI G1124 (1-17) 02/24/2017 NWAN, INC. NI G1139 (2-17) 03/27/2017 NWAN, INC. JD G1158 (2-17) 03/27/2017 NWAN, INC. JD G1163 (2-17) 03/27/2017 NWAN, INC. JD G1166 (7-17) 08/04/2017 NWAN, INC. JD G1172 (7-17) 08/04/2017 NWAN, INC. NI G1123 (7-17) 08/04/2017 NWAN, INC. NI G1124 (7-17) 08/04/2017 NWAN, Inc. JD G1189 (8-18) 10/26/2018 Old Republic Insured Automotive Services, Inc. GAP06-Waiver125-TX (10/11) 10/14/2011 Old Republic Insured Automotive Services, Inc. GAP06-Waiver150-TX (10/11) 10/15/2011 Old Republic Insured Automotive Services, Inc. GAP06-Waiver150-TX (11/11) 12/19/2011 Old Republic Insured Automotive Services, Inc. GAP06-Waiver150-TX FRD (12/11) 01/26/2012 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. GAP15-Waiver125-TX (2/18) 02/16/2018 Old Republic Insured Automotive Services, Inc. GAP15-Waiver150-TX (2/18) 02/16/2018 Old Republic Insured Automotive Services, Inc. GAP15-Waiver150-TX FRD (2/18) 02/16/2018 Old Republic Insured Automotive Services, Inc. GAP15-Waiver150-TX TFS (2/18) 02/16/2018 Old Republic Insured Automotive Services, Inc. GAP15-Waiver150-TX TFS (4/18) 05/29/2018 Old Republic Insured Automotive Services, Inc. GAP18-Waiver150-TX (9/18) 09/27/2018 Old Republic Insured Automotive Services, Inc. GAP18-Waiver150-TX FRD (9/18) 09/27/2018 Old Republic Insured Automotive Services, Inc. GAP18-Waiver125-TX (9/18) 09/27/2018 Old Republic Insured Automotive Services, Inc. GAP18-Waiver150-TX TFS (8/18) 10/07/2018 OwnerGUARD Coporation TX.AFA.0616.01B_K rev 11-16 11/22/2016 OwnerGUARD Coporation TX.AFA.0616.01BF_K rev 11-16 11/22/2016 OwnerGUARD Coporation TX.AFA.0616.01BF_KFMCC 03/31/2017 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 TX.AFA.0616.01B_K rev 09-17 01/19/2018 OwnerGUARD Corporation 11FDS0118.TX 03/01/2018 OwnerGUARD Corporation TX.AFA.0616.01B_K rev 06-18 08/09/2018
Page 16 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved Partners Alliance Corporation FI 2000 (150 TX) 02/18 04/11/2018 Phoenix GAP PAFG 01/18/2012 Phoenix GAP PAGIN 01/18/2012 Phoenix GAP PGAPF TX 100 12/15 03/21/2016 Phoenix GAP PGAPI TX 100 12/15 03/21/2016 Phoenix GAP RVGAP TX 101 (12/15) 07/26/2016 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 Plateau Service Company GAP Waiver TX PR-R Plan F (07/15) 08/26/2015 Plateau Service Company GAP Waiver TX PR-R 12/18/2015 Plateau Service Company GAP Waiver TX Plan RE 12/18/2015 Power Protect Extended Services, Inc. KIGP-TX rev 1/15 02/20/2015 Power Protect Extended Services, Inc. PPESGP-TX Rev 9/18 11/09/2018 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 Preferred 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 Administrators SGF-150-TX 04/18 08/21/2018 Preferred Automobile Credit Co. Ltd. (PACCO) HC# 4845-3309-7744v.3 07/18/2012 Premier Dealer Services, Inc. TXRVGAP-01 (6/12) 10/12/2012 Premier Dealer Services, Inc. AGAP-RV-TX (9/13) 01/22/2014 Premier Dealer Services, Inc. AGAP-ULT-TX (9/13) 02/03/2014 Premier Dealer Services, Inc. AGAP-ULT-TX (12/13) 03/18/2014 Premier Dealer Services, Inc. FC-19971-TX 03/14 06/27/2014
Page 18 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved 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 (7/14) 08/26/2014 Premier Dealer Services, Inc. AGAP-ULT-TX (1/15) 02/25/2015 Premier Dealer Services, Inc. AGAP-ULT-TX - TOY (3/15) 04/24/2015 Premier Dealer Services, Inc. AGAP-ULT-TX-TOY (5/15) 08/06/2015 Premier Dealer Services, Inc. FC-19971-CL-TX 12/15 04/07/2016 Premier Dealer Services, Inc. AGAP-ULT-TX-TOY (04/16) 05/13/2016 Premier Dealer Services, Inc. FC-19971-TX (12/16) 01/03/2017 Premier Dealer Services, Inc. GEN-19971-TX (12/16) 01/03/2017 Premier Dealer Services, Inc. LI-19971-TX (12/16) 01/03/2017 Premier Dealer Services, Inc. AGAP-ULT-TX (4/17) 05/19/2017 Premier Dealer Services, Inc. FC-19971-TX (10/17) 09/22/2017 Premier Dealer Services, Inc. GEN-19971-TX (10/17) 09/22/2017 Premier Dealer Services, Inc. LI-19971-TX (10/17) 09/22/2017 Premier Dealer Services, Inc. AGAP-ULT-TX (9/18) 11/01/2018 Premier Dealer Services, Inc. TXGAP-02 (9/11) 10/21/2011 Premier Dealer Services, Inc. TXGAPUL-02 (9/11) 10/21/2011 Premier Dealer Services, Inc. TXGAPUL-03 (12/11) 01/25/2012 Premier Dealer Services, Inc. TXGAPUL-04 (5/12) 06/25/2012 Premier Dealer Services, Inc. AGAP-ULT-TX-SR (11/17) 12/15/2017 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 ProGuard Warranty Form PGW/GT - 6/18 08/07/2018 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 Regional Insurance Services Company, Inc. TRCOG00150 CH (10/11) TX 01/04/2012 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 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 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
Page 19 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved 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 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 FA205 (150SGTX) 02/17/2012 Reinsurance Associates, Inc. d/b/a Financial GAP Administrator FA205 (GDPETX) 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 FC416 06/07/2012 Royal Administration Services, Inc Royal GAPADD-009 TX Rev. 09-12 11/16/2012 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 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 INGPFM-TX 06/14/2012 Safe-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 CMGPSET-TX Rev. 06/12 (also shows form number PFF2036TX) 08/24/2012
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved Safe-Guard Products International, LLC MIGP-TX Rev 8/17 10/24/2017 Safe-Guard Products International, LLC BMGP-TX Rev 8/17 10/24/2017 Safe-Guard Products International, LLC SGMGP15-TX 10/17 11/30/2017 Safe-Guard Products International, LLC LAGP-TX Rev 11/17 01/19/2018 Safe-Guard Products International, LLC BEGP-TX Rev 11/17 01/19/2018 Safe-Guard Products International, LLC POGP-TX Rev 11/17 01/19/2018 Safe-Guard Products International, LLC QSGP-TX Rev 11/17 01/19/2018 Safe-Guard Products International, LLC AUGP-TX Rev 2/18 03/26/2018 Safe-Guard Products International, LLC QPGP-TX Rev 2/18 03/26/2018 Safe-Guard Products International, LLC VWGP-TX Rev 2/18 03/26/2018 Safe-Guard Products International, LLC QPMGP-TX Rev 2/18 03/26/2018 Safe-Guard Products International, LLC DUMGP-TX Rev 2/18 03/26/2018 Safe-Guard Products International, LLC ANGPTX-TFS Rev 6/18 07/30/2018 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 SilverRock Automotive, Inc (CARVANA, LLC) GAP (CV-TX) 06-2017 06/15/2017 South Texas Acceptance Corp. FL629477 Q 06/13/2013 Southwest Reinsure, Inc. CLW-TX-XX-01 10/31/2016 Southwest Reinsure, Inc. CLW-TX-XX-02 LZX 12293 REV 12.09.16 01/30/2017
Page 22 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved Southwest Reinsure, Inc. CQL-TX-XX-01 02.07.18 06/04/2018 Southwest Reinsure, Inc. CQM-TX-XX-01 02.07.18 06/04/2018 Southwest Reinsure, Inc. CQO-TX-XX-01 02.07.18 06/04/2018 Southwest Reinsure, Inc. CQP-TX-XX-01 02.07.18 06/04/2018 Southwest Reinsure, Inc. CQQ-TX-XX-01 02.07.18 06/04/2018 Southwest Reinsure, Inc. COJ-TX-XX-01 05.01.18 07/10/2018 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 Summit 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 SWBCTX150 08/07/2012 SWBC RBDTX 05/13 06/14/2013 SWBC-American National (ANICO) SWBCTX150_2DLQ 10/08/2014 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. SGNB150 (Rev. 1/2012) TX 07/30/2012 T.A.S.A of KY, Inc. SGNB150 (Rev. 11/2012) TX 01/03/2013 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. GG 150 TX 08/2018 10/29/2018 T.A.S.A of KY, Inc. GG150-TX FE 08/2018 10/29/2018 T.A.S.A of KY, Inc. GG150-TX FMC 08/2018 10/29/2018 T.A.S.A of KY, Inc. GG150-TX FE FMC 08/2018 10/29/2018 T.A.S.A of KY, Inc. DG125-TX 03/18 05/18/2018 T.A.S.A of KY, Inc. DG150-TX 03/18 05/18/2018 T.A.S.A of KY, Inc. TG125-TX 03/18 05/18/2018 T.A.S.A of KY, Inc. TG150-TX 03/18 05/18/2018 T.A.S.A of KY, Inc. DG150-TX FMC 05/2018 06/29/2018 T.A.S.A of KY, Inc. TG150-TX FMC 05/2018 06/29/2018 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 T.A.S.A. of KY, Inc. TGA00135 RV (5/15) TX 07/17/2015
Page 23 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved T.A.S.A. of KY, Inc. CG00125BHPH CH (07/17) EF TX 09/01/2017 T.A.S.A. of KY, Inc. CG00150 CH (07/17) EF TX 09/01/2017 Talanton Protection, Inc GAP-TX (9/2017) 10/06/2017 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/TX150/1011 11/04/2011 The Wildfire Group, LLC d/b/a Total Loss Coverage Gap TLC/TXNF125/1011 11/04/2011 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/LibertyTXRV/0117 01/06/2017 The Wildfire Group, LLC d/b/a Total Loss Coverage Gap TLC/TXRV/0117 04/27/2017 The Wildfire Group, LLC d/b/a Total Loss Coverage Gap EG/TXRV/0117 04/27/2017 The Wildfire Group, LLC d/b/a Total Loss Coverage Gap TLC/TXRV/0917 09/27/2017 The Wildfire Group, LLC d/b/a Total Loss Coverage Gap EG/TXRV/0917 09/27/2017 The Wildfire Group, LLC d/b/a Total Loss Coverage Gap EG/TXRV/0518 07/06/2018 The Wildfire Group, LLC d/b/a Total Loss Coverage Gap TLC/TXRV/0518 07/06/2018 The Wildfire Group, LLC d/b/a Total Loss Coverage Gap EG/AIC/TXWatercraft/0818 09/20/2018 The Wildfire Group, LLC d/b/a Total Loss Coverage Gap TLC/AIC/TXWatercraft/0818 09/20/2018 Toyota Motor Insurance Services, Inc. 111542 12/01/2011 Toyota Motor Insurance Services, Inc. 111542U 12/01/2011 Toyota Motor Insurance Services, Inc. 111542XE 3116TX (03/01/12) 03/01/2012 Toyota Motor Insurance Services, Inc. 171542 (Eff 03/01/18) 3533TX (09/17) 11/21/2017 Toyota Motor Insurance Services, Inc. 171542XE (Eff 03/01/18) 3116TX (08/30/17) 11/21/2017 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 Auto Credit Corporation UACC Form 521 - 12/17 - Previously editions MAY NOT be used 03/06/2018 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
Page 24 of 27
Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved United States Warranty Corp. GAP USWC NON TUC PC TX 9-18 08/13/2018 United States Warranty Corp. GAP USWC TUC PC TX 9-18 08/13/2018 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 Universal Warranty Corporation GCA-150 PRO UWC FT TX (01/15) 12/17/2014 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 GAP-150-PRO-DLR-DLPF-TX (10/14) 06/17/2015 Universal Warranty Corporation GAP-150-PRO-DLR-DLPT-TX (10/15) 01/27/2016 Universal Warranty Corporation V1 150 PRO DLR CSCI TX (09-16) 09/28/2016 Universal Warranty Corporation GCA 150 PRO DLR CSCI TX )09-16) 09/28/2016 Universal Warranty Corporation GAP-150-PRO-DLR-TX (09-16) 09/28/2016 Universal Warranty Corporation V1 150 PRO DLR CSCI TX (09-16) 09/28/2016 Universal Warranty Corporation GAP-150-PRO-DLR-TX (09-16) 09/28/2016 Universal Warranty Corporation GCA 150 PRO DLR CSCI TX (09-16) 09/28/2016 Universal Warranty Corporation GAP-150-PRO-DLR-DLPT-TX (03-17) 06/07/2017 Universal Warranty Corporation GAP-150-PRO-DLR-TX (11-17) 11/06/2017 Universal Warranty Corporation GAP-150-PRO-DLR-DLPT-TX (9-17) 11/17/2017 Universal Warranty Corporation (Ally) GAP-150-PRO-TX (04-18) 02/22/2018 US Auto Credit Purchasing Center LLC dba US Auto Credit TXABDCA (201707) 08/25/2017 Vantage Administration Services dba Roadvantage GTX125_030118 04/25/2018 Vantage Administration Services dba Roadvantage GTX150_030118 04/25/2018 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 VPD125/150res-0214 04/03/2014 Vehicle Protection Direct VPD125/150res-0214 04/03/2014 Vehicle Protection Direct VPD125/150res-0214 07/29/2015 Vehicle Protection Direct VPD150res-1113 09/25/2015 Vehicle Protection Inc. CPG0202C17 Standard TX 150 03/17/2017
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Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved Vehicle Protection Inc. CPG1203C17 Fully Earned TX 150 03/17/2017 Vehicle Protection Inc. CRG0402F17 10/02/2017 Vehicle Protection Services vpdLegaltexas 125 9-13 10/18/2013 Vehicle Protection Services vpdLegaltexas 125 9-13 10/18/2013 Vehicle Protection Services LLC VPD150res-1113 12/19/2013 Vehicle Protection Services LLC VPD150res-1113 12/19/2013 Vehicle Protection Services LLC vpd 150 ndl 6-14 09/30/2014 Vehicle Protection, Inc. AMTTXS2 08/16 09/29/2016 Vehicle Protection, Inc. AMTTXS5 08/16 09/29/2016 Vehicle Protection, Inc. CPG0302K17 01/03/2018 Vehicle Protection, Inc. CPG1303K17 01/03/2018 Vehicle Protection, Inc. CPG0304K17 01/03/2018 Vehicle Protection, Inc. CPG1309K17 01/03/2018 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 Automotive, Inc. 11WGAP0812_TX_125 REV1016 11/01/2016 Warrantech Automotive, Inc. 11WGAP0812_TX_150 REV1016 11/01/2016 Warrantech Automotive, Inc. 11WGAP0812_TX 120 REV1016 12/14/2016 Warrantech Automotive, Inc. 11BEG0318.TX 11/01/2018 Warrantech Automotive, Inc. TX.AFA.0917.01B_K 175 10/25/2017 Warrantech Automotive, Inc. 11CGAP0718_TX_150 09/06/2018 Warrantech Automptive, Inc. 11CGAP1014_TX_-150 05/21/2015 Warranty Solutions: An AmTrust Company TG7F (Rev 04/17) 06/19/2017 Warranty Solutions: An AmTrust Company TG75 (Rev 04/17) 06/19/2017 Western Diversified Services Inc GAP-ADDM2429-NON TUC-CAC-TX (12/17) 12/20/2017 Western Diversified Services, Inc. GAP-ADDM2429-NCF-NON TUC-TX (3/16) 11/30/2015 Western 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
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Debt Cancellation Agreement Forms Approved by the OCCC Approved as of: 11/30/2018
Name Form Number Date Approved Western General Insurance Company d/b/a Western General Automobile Insurance Company WGIC-816 TX (REV. 01/12) 12/21/2011 Westlake Services, LLC dba Westlake Financial Services/ Knight Management Insurane Services LLC WFS MULTI-STATE GAP 12/17 | Form No: 801.1608.KMIS 12/21/2017 WNC Insurance Services Inc. ABCDEI-OC 10/21/2011 Wynn's GAP (Phoenix American Administrators Inc) WGAPCA TX 100 (09/17) 11/10/2017 Wynn's GAP (Phoenix American Administrators Inc) WGAPCA TX 101 (03/18) 05/04/2018 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 V45400HR (08/16) 08/09/2016 Zurich GDTX0816 (08/16) 08/24/2016 Zurich (Universal Underwriters Insurance Co./Universal Underwriters Service Corp.) V45560JS (09/17) 09/27/2017 Zurich (Universal Underwriters Insurance Co./Universal Underwriters Service Corp.) V45600JS (09/17) 09/27/2017 Zurich (Universal Underwriters Insurance Co./Universal Underwriters Service Corp.) V45630JS (09/17) 09/27/2017 Zurich (Universal Underwriters Insurance Co./Universal Underwriters Service Corp.) V45640JS (09/17) 09/27/2017 Zurich (Universal Underwriters Insurance Co./Universal Underwriters Service Corp.) V45650JS (09/17) 09/27/2017 Zurich (Universal Underwriters Insurance Co./Universal Underwriters Service Corp.) V45660JS (09/17) 09/27/2017 Zurich (Universal Underwriters Insurance Company-CLP provider) (Universal Underwriters Service Corporation - V45860CT (03/18) 06/18/2018 Zurich d/b/a Universal Underwriters Serivce Corporation V44580HQ (08/15) 08/06/2015 Zurich d/b/a Universal Underwriters Serivce Corporation GDTX0816 (08/16) 08/24/2016