California Code of Regulations
Title 10 - Investment
Chapter 3 - Commissioner of Financial Protection and Innovation
Subchapter 11 - Securities Depositories
Section 1805.204 - Application for Certificate
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
An application for a certificate as a securities depository shall be made on the following form:
DEPARTMENT OF BUSINESS OVERSIGHT FILE NO.
______________________________
(insert file number of previous filings before the Department, if any.)
FEE: $2,500 (not refundable)
Date of Application_________________________
DEPARTMENT OF BUSINESS OVERSIGHT STATE OF CALIFORNIA
INDICATE THE TYPE OF FILING BY CHECKING EITHER THE ORIGINAL OR AMENDMENT APPLICATION HEADING SHOWN BELOW.
[] ORIGINAL APPLICATION FOR A CERTIFICATE AS A SECURITIES DEPOSITORY PURSUANT TO SECTION 30204 OF THE SECURITIES DEPOSITORY LAW.
[] AMENDMENT TO APPLICATION FOR A CERTIFICATE AS A SECURITIES DEPOSITORY PURSUANT TO SECTION 1805.213.1 OF TITLE 10 OF THE CALIFORNIA CODE OF REGULATIONS.
1. Name of Applicant (Complete name as appearing on articles of incorporation)
___________________________
2. Address of principal office of applicant
Number and Street | City | State | Zip Code | |
___________________________ |
3. Address of principal office of applicant in the State of California
Number and Street | City | State | Zip Code | |
___________________________ |
4. Name and address of person to whom communications should be addressed concerning this application
___________________________
5. | (a) State in which applicant was incorporated: | ___________________________ |
(b) Date on which applicant was incorporated: | ___________________________ | |
(c) Is applicant in good standing in the State of its incorporation? | ___________________________ | |
Indicate "yes" or "no" | ||
___________________________ |
6. The name and address of the independent certified public accountant or independent public accountant retained, or to be retained, by the applicant to report upon or certify its financial statements in accordance with Section 30213 of the Financial Code is:
___________________________
Name:
Address:
7. There are attached as exhibits the following which are incorporated herein by reference:
8. There is attached, for each person identified in Exhibit A to this application as an incorporator, director or officer of the applicant, a statement executed by such person in the form prescribed by Section 1805.204.1 of Title 10 of the California Code of Regulations.
9. Pursuant to Section 1805.213.1 of Title 10 of the California Administrative Code, applicant hereby undertakes to notify the Commissioner promptly, and in no event later than 30 days after the occurrence, of any changes in the information set forth in this application by filing with the Commissioner an amendment to this application on this form setting forth the changed items only. (Instruction: Such undertaking is applicable to all matters except financial statements which are otherwise covered by the provisions of Section 1805.213 of Title 10 of the California Code of Regulations.)
10. The name of the applicant's workmen's compensation insurance carrier, if any, is. The applicant is aware of the provisions of Section 3700 of the Labor Code which requires every employer to be insured against liability for workmen's compensation.
11. The applicant acknowledges on behalf of the undersigned that the State Board of Equalization and the Franchise Tax Board are authorized to share taxpayer information with the Department of Business Oversight, and in the event the state tax obligation is not paid by a certificate holder after a certificate has been accepted, the Department of Business Oversight may be required to suspend the certificate (Business and Professions Code Sections 31 and 494.5).
12. The applicant has duly caused this application to be signed on its behalf by the undersigned, thereunto duly authorized.
______________________________
(Applicant)
By______________________________
______________________________
(Title)
I declare under penalty of perjury that I have read this application and the exhibits thereto and know the contents thereof and that the statements therein are true. Executed at _________________________ California,_______________ 20__________
______________________________
(Signature of Declarant)
(If executed outside of California, attach a verification executed and sworn to before a notary public.)
Form 1805.204
1. Amendment
filed 9-12-73; effective thirtieth day thereafter (Register 73, No.
37).
2. Editorial correction adding NOTE filed 3-9-83 (Register 83,
No. 11).
3. Editorial correction of NOTE filed 6-24-83 (Register 83,
No. 26).
4. Change without regulatory effect amending section filed
9-25-2002 pursuant to section
100, title 1, California Code of
Regulations (Register 2002, No. 39).
5. Amendment of section and
NOTE filed 1-7-2014; operative 1-7-2014 pursuant to Government Code section
11343.4(b)(3)
(Register 2014, No. 2).
Note: Authority cited: Sections 30006 and 30204, Financial Code. Reference: Sections 31 and 494.5, Business and Professions Code; and Section 30204, Financial Code.