Fillable Printable Rtb 2011 048 Attachment1
Fillable Printable Rtb 2011 048 Attachment1
Rtb 2011 048 Attachment1
VTR-331
(09/11)
Page 1 of 2
Insurance Company or Salvage Pool Operator Statement of Facts
This form may not be used for any vehicle claim paid prior to September 1, 2011
PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS APPLICATION.
Additional attachment information is included on page 2
This statement must be submitted with the appropriate salvage or nonrepairable title application for an insurance-claim vehicle, Form
VTR-441, $8 fee and the following:
If Insurance Company:
1) Proof of paid claim for vehicle;
2) Any title documents surrendered by owner of record
1
; and
3) If vehicle is titled out-of-state, Form VTR-221, and a valid title record communication
2
from other state’s motor vehicle
authority must also be attached.
If Salvage Pool Operator, copies of:
1) Insurance company notification to pick up the vehicle, and its subsequent claim status; and
2) Evidence of Certified or Registered Notice to recorded owner(s), and lienholders, if applicable.
Check title type: Salvage Vehicle Title Nonrepairable VehicleTitle
APPLICANT INFORMATION– Type or print only
Day Phone Name of Licensed Salvage Pool Operator or Insurance Company
E-mail (optional)
Address City State ZIP
Day Phone
If applicant is Salvage Pool Operator, name of authorizing Insurance CompanyDate claim paid
E-mail (optional)
Insurance Company Address City State ZIP
Printed Contact Name: If Salvage Pool Operator:
License #:
_________________ Expiration Date: __________________
VEHICLE INFORMATION
Vehicle Identification Number Year Model Make Body Style Model Color
License Plate Number
Previous Title Number Previous Title State
INSURANCE COMPANY STATEMENT
I certify that I am an authorized representative of the above named insurance company; that a loss claim was paid and accepted for this
vehicle; and that two separate written notices were sent to the owner of record requesting surrender, or proper assignment, of the
original vehicle title. The statements on this application for the above described vehicle are true and correct to the best of my
knowledge.
Printed Name of Applicant ________________________ Signature ____________________________ Date ____________
LICENSED SALVAGE POOL OPERATOR STATEMENT
I certify that the above named insurance company requested possession of this vehicle, and either denied payment of a claim against it,
or will not take any other possession. I have notified the owner(s) and lienholders to remove the vehicle from my facility and the vehicle
has not been retrieved. By law I am authorized to apply for title on this vehicle in order sell it. I certify the statements on this application
for the above described vehicle are true and correct to the best of my knowledge.
Printed Name of Applicant ________________________ Signature ____________________________ Date ____________
WARNING: Transportation Code, §501.155, provides that falsifying information on title transfer documents is a third-degree
felony offense punishable by not more than ten (10) years in prison or not more than one (1) year in a community correctional
facility. In addition to imprisonment, a fine of up to $10,000 may also be imposed.
VTR-331
(09/11)
Page 2 of 2
CHECKLISTS TO AVOID REJECTION OR ISSUANCE OF INCORRECT VEHICLE TITLE:
ALL
APPLICANTS:
Check type of title (salvage or nonrepairable)∙$8 fee and Form VTR-441 are included.
Complete name and address of title applicant is
provided
∙
This form may not be used for any vehicle claim paid
prior to September 1, 2011.
Title applicant/agent has signed and dated the
application
Additional items to include:
INSURANCE COMPANY APPLICANT:
Evidence of payment made to vehicle owner
If vehicle is titled out-of state, Form VTR-221 and a valid title record communication² from the other state’s motor vehicle
authority.
1
Original unassigned title document, if available
SALVAGE POOL OPERATOR APPLICANT:
Copy of specific Insurance company notification(s) regarding vehicle claim and denial, or other refusal to own is
attached.
Proof of certified or registered mail notice sent to owner(s) of record, or lienholder, if applicable, is attached.
Salvage Pool Operator license and expiration date is provided.
1
If an owner has surrendered the original title with acceptance of the insurance claim payment, but either failed to assign
or improperly assigned the document, the title must be surrendered to the department with any new title application.
2
If a request for title and registration verification is sent to the state of record and you are informed by that state that, due
to the Driver’s Privacy Protection Act restrictions, the state is unwilling or unable to provide information on the last known
registered owner, or any lienholder of record, a copy of that communication must be attached.
ADDITIONAL INFORMATION
Transportation Code, Chapter 501, Subchapter E, provides that a person who acquires ownership of a salvage or
nonrepairable motor vehicle, regardless of the year model, must apply for a Texas Salvage or Nonrepairable Vehicle Title
prior to further transfer of ownership. If applying for a Texas Salvage or Nonrepairable Vehicle Title, VTR Form-441 must
be attached.
NOTE: Transportation Code §501.0935, requires a Salvage Pool Operator issued a salvage or nonrepairable title
based on an insurance claim, to sell the vehicle and pay any excess proceeds from the sale to the previous
owner of record, or if owner cannot be located, proceeds must be paid to the State Comptroller. If a
lienholder is listed on the title record, any owner payment must be mailed to the lienholder.
