TEXAS LAWYERS' INSURANCE EXCHANGE
Application for Judges' Claims Made Professional Liability Insurance Policy
Please complete and forward to Texas Lawyers' Insurance Exchange, P. O. Box 
13325, Austin, TX 78711

1.   Full name of Judge:


2.   Who should we contact first if we have a question about your application?




3.   Principal office address (list secondary locations on separate sheet):

     Street:
     P. O. Box:
     City:                                State:           Zip:
     Phone:  (   )                        FAX: (   )
     Email:


4.   Court over which applicant presides:


5.   Number of years in which you have presided:


6.   Number of years of overall judicial experience:


7.   (a) Date you were admitted to Texas Bar:

     (b) Bar Card Number:

     (c) Member of following Bar Associations:




8.   Previous judicial liability insurance (last 4 years):

     Name of Company:
     Limits:
     Effective Dates:

     Name of Company:
     Limits:
     Effective Dates:

     Name of Company:
     Limits:
     Effective Dates:

     Name of Company:
     Limits:
     Effective Dates:


9.   Has the applicant ever had similar insurance cancelled or declined?

     [ ] Yes    [ ] No   If Yes, please provide details on a separate sheet.


10.  Has the applicant ever had any professional liability claims asserted or 
     action filed against him or her, or has a claim been paid on behalf of 
     the applicant?

     [ ] Yes    [ ] No   If Yes, attach a description of the situation.


11.  Has the applicant ever been reprimanded or had his or her rights to serve 
     as a judge suspended (including voluntary suspension)?

     [ ] Yes    [ ] No   If Yes, please provide details on a separate sheet.


12.  Does the applicant know of any circumstance, act, error or omission which 
     could form the basis of a claim against the applicant? If you know of such 
     a circumstance, act, error or omission, please provide details.  Please 
     include details of any threat of a claim, even if you feel it is 
     unjustified or frivolous.  If you have notified another insurance company 
     of any such circumstance, act, error or omission, please provide a copy of 
     that notice.

All TLIE Judges' Professional Liability Insurance Policies have a limit of 
$1,000,000 per claim and a $1,000,000 aggregate, with a $1,000 deductible.

*Please note that your policy will not go into effect until you have satisfied 
the Association underwriting requirements.


WARRANTY

I hereby warrant and declare that the foregoing statements and particulars are 
true and that I have not suppressed or misstated any material facts and I agree 
that this application shall be the basis of the contract with the Association; 
and it is agreed that all representations contained herein are material as a 
matter of law, and that I will immediately notify the Association, said 
representations being deemed continuous, of any change in facts occurring prior 
to issuance of insurance pursuant hereto.

I hereby authorize release to the Association or its authorized representative, 
by any State Bar Association, my present and prior professional liability 
insurance carriers, or any other sources, any claims, underwriting, or other 
information having a bearing upon my acceptability as a professional liability 
insurance risk.

It is understood that this is an application for insurance and not an insurance 
binder.  CAUTION:  Any misstatements made in this application could invalidate 
any policy issued on the basis of this application.

Applicant's Name (type or print):
Date:
Authorized Signature:


IMPORTANT:  To complete this application, please execute the Subscriber's 
Agreement and Power of Attorney located on the Back Page.


SUBSCRIBER'S AGREEMENT AND POWER OF ATTORNEY

The undersigned, hereafter known as the Subscriber, agrees with other 
subscribers at an Exchange known as the TEXAS LAWYERS' INSURANCE EXCHANGE, 
hereinafter referred to as the Association, located in Austin, Texas, to 
exchange private contracts of indemnity.  To that end, I hereby appoint the 
President of the Association and/or such person or persons as may be designated 
by the Board of Directors in accordance with Section 8, Article VIII of the 
Bylaws, and licensed by the Commissioner of Insurance of the State of Texas, 
with full powers of substitution and revocation, and with authority to act 
jointly or severally, as my Attorney-in-Fact, in my name, place and stead, to 
represent me in the following matters:

1. To exchange with other subscribers at such Exchange, insurance coverages as 
now or hereafter authorized by the Board of Directors; to subscribe and deliver 
all proper contracts of insurance; to take any action in furtherance of the 
exchange of such contracts of insurance; to do and perform every other thing 
that I could do in respect to such contracts so exchanged, including the 
appearance and defense in my name in actions and proceedings; and to manage and 
conduct the business, affairs and property of the Exchange under the supervision 
of the Board of Directors.

2. The powers hereby vested in my said attorney shall be exercised only in 
accord with the decisions of the Board of Directors of the Association, provided 
that the said attorney may deputize such person or persons as may be appointed 
therefore by the Board of Directors of the Association, to authenticate the 
policy contracts now applied for or those that I may hereafter apply for, and 
all papers pertaining thereto.  It is understood that the subscribers reserve 
unto themselves the right to govern the Association according to the decision of 
a majority of subscribers present in person or by proxy at any meeting.

3.  I adopt as a part of this agreement the Bylaws of the Exchange now or 
hereafter effective.

4.  I agree that this Power of Attorney shall have application to all insurance 
applied for by me, including such modifications or changes in any of my 
insurance as may be made at my request, and the representations made by me in 
connection with each policy shall have the same force and effect as if contained 
in this instrument.

5.  I agree that to the fullest extent now or hereafter permitted by law, no 
director of the Exchange shall be personally liable to the Exchange or to its 
Subscribers for monetary damages for any act or omission in the director's 
capacity as a director except liability for (i) a breach of a director's duty of 
loyalty to the Exchange or its Subscribers, (ii) an act or omission not in good 
faith or that involves intentional misconduct or a knowing violation of the law, 
(iii) a transaction from which a director received an improper benefit, whether 
or not the benefit resulted from an action taken within the scope of the 
director's office, (iv) an act or omission for which the liability of a director 
is expressly provided for by statute, or (v) an act related to an unlawful stock 
repurchase or payment of a dividend.  Any repeal or modification of the 
foregoing paragraph by the Subscribers of the Exchange shall not adversely 
affect any right or protection of a director of the Exchange existing at the 
time of such repeal or modification.  The effective date of the limitation of 
liability provided by this paragraph shall be the due date of member approval of 
this Paragraph 5.

6.  I agree further that this Power of Attorney shall be and become effective on 
the date hereof, and shall remain in force and effect only so long as I have a 
contract of insurance with the Exchange.  This power of attorney shall not 
terminate on disability of the principal.  This agreement is strictly limited to 
the use and the purpose herein expressed and to no other purpose.

Date:

Applicant Name:

By:

Authorized Signature:

Position:


AN EXPLANATION OF THE POWER OF ATTORNEY

A power of attorney is an instrument authorizing a person to act as the agent of 
the person granting the power.  The person acting as the agent is known as an 
attorney-in-fact.  A special power is one limited to particular acts.  The power 
of attorney is a special one, pertaining only to your insurance business with 
the Association and limited to the subjects described in the instrument.

The Association is that form of an insurance concern known as a reciprocal 
exchange.  The members act collectively through attorneys-in-fact, insuring each 
of the members.  The power of attorney is the legal device whereby the contracts 
may be executed thus eliminating the necessity of all the members signing each 
contract.


IMPORTANT

The TLIE policy for judges does not cover acts or omissions of applicant in 
practicing law as an attorney.  If applicant has previously had a private 
practice or continues some private practice, TLIE recommends purchasing of a 
"claims made" policy for attorneys.