California Code of Regulations
Title 10 - Investment
Chapter 3 - Commissioner of Financial Protection and Innovation
Subchapter 2.3 - Capital Access Companies
Article 2 - Application for Licensure and Related Forms
Section 280.153 - Notice of Officers, Directors, Partners, "Control" Persons, Managers, Members, Trustees and Employees
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) The notice to accompany the filing of an individual's fingerprints required in the following circumstances shall be made on the form set forth in subsection (b) of this rule:
(b) The notice shall be made on the following form:
Fee: $20.00 + DOJ Noncriminal Applicant Fingerprint Fee
(Fees should include the Department of Business Oversight's filing fee of [$20.00] and the fee charged by the Department of Justice [Penal Code Section 11105] for processing Noncriminal Applicant Fingerprints.)
Receipt No.__________
STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT
NOTICE OF OFFICERS, DIRECTORS, PARTNERS, "CONTROL" PERSONS, MANAGERS, MEMBERS, TRUSTEES AND EMPLOYEES OF A CAPITAL ACCESS COMPANY*
OFFICIAL USE ONLY
LAST NAME__________
Date submitted CII:__________
Applicant I.D. #__________
PLEASE PRINT OR TYPE
| NAME OF COMPANY:___________________________ | FILE NO.___________________________ | |||
| ADDRESS OF MAIN OFFICE:___________________________ | ||||
| (Street) | (City) | (State) | (Zip Code) | |
EMPLOYING BRANCH OFFICE: __________
NAME OF OFFICER, DIRECTOR, PARTNER, "CONTROL" PERSON, MANAGER, MEMBER, TRUSTEE AND EMPLOYEE:
| ___________________________ | |||
| (Last) | (First) | (Middle) | |
POSITION HELD OR TO BE HELD: __________
| HOME ADDRESS:___________________________ | ||||
| (Street) | (City) | (State) | (Zip Code) | |
| DATE OF BIRTH:___________________________ | PLACE OF BIRTH:___________________________ | |||
| (Month) | (Day) | (Year) | ||
| HEIGHT:___________________________ | WEIGHT:___________________________ | SEX:___________________________ | COLOR OF EYES:___________________________ | |
| COLOR OF HAIR:___________________________ |
* This document shall be treated by the Department of Business Oversight as being received in confidence pursuant to paragraph (4) of subdivision (d) of Section 6254 of the Government Code.
1. New
section filed 6-24-99; operative 7-1-99 pursuant to Government Code section
11343.4(d)
(Register 99, No. 26).
2. Change without regulatory effect amending
form within subsection (b) filed 8-13-2014 pursuant to section
100, title 1, California Code of
Regulations (Register 2014, No. 33).
Note: Authority cited: Section 28951, Corporations Code. Reference: Sections 28104(a)(1), 28152(d), 28152(e) and (f), 28153 and 28552, Corporations Code.
