California Code of Regulations
Title 10 - Investment
Chapter 3 - Commissioner of Financial Protection and Innovation
Subchapter 6 - California Financing Law
Article 2 - Applications
Section 1422 - Application for License Under the California Financing Law; Form
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a)
STATE OF CALIFORNIA DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATION
INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR A FINANCE LENDER OR BROKER LICENSE UNDER THE CALIFORNIA FINANCING LAW (CFL)
WHO IS REQUIRED TO OBTAIN A LICENSE UNDER THE CALIFORNIA FINANCING LAW?
In general, any person engaging in the business of a finance lender, a broker, or a program administrator must obtain a license under the California Financing Law. The CFL contains a number of exemptions for persons licensed by other regulatory agencies. The CFL does not contain any licensing exemptions for program administrators, although the definition of "program administrator" excludes certain persons.
A broker license under the CFL only authorizes a broker to broker loans to licensed finance lenders. The license does not provide the broker with the authority to broker loans to and collect brokerage commissions from other types of lenders such as credit unions and banks. Therefore, a broker who brokers loans to financial institutions that are not CFL licensees should confirm that no other state licensing law is applicable to the brokering activity (such as the Real Estate Law).
On or after October 1, 2021, all applicants must initiate an application for a license through NMLS and not through the submission of this application. All licensees must transition onto NMLS by December 31, 2021.
ASSISTANCE WITH THE APPLICATION
Refer to these instructions while completing the CFL application. If you have questions about the application that are not answered by these instructions, call the Department of Financial Protection and Innovation's toll-free telephone number at 1-866-275-2677. Departmental personnel cannot provide individual legal or accounting advice. Applicants who need such advice must consult a qualified professional.
FEES AND PROCESSING OF THE APPLICATION
The application and all exhibits must be typewritten. Attach additional sheets if you need more space to complete an answer to any of the questions. Answer every question in the application, unless these instructions direct otherwise, and label the answers by the corresponding question number or exhibit letter.
The application, including all exhibits, must be accompanied by a nonrefundable application fee of $200, an investigation fee of $100, and fingerprint processing fees. The applicable fingerprint processing fee is $20 per individual if the individual resides in California. If the individual resides outside of California, the applicable fingerprint processing fee is $86 per individual. The application fee, investigation fee, and fingerprint processing fees are not refundable if the application is denied or withdrawn. Detailed instructions for the fingerprint processing requirements are listed below under "Exhibit C."
Make check(s) payable to the Department of Financial Protection and Innovation for the total amount of all fees. The application, exhibits, and fees must be filed only in the Los Angeles office of the Department of Financial Protection and Innovation, located at 320 West 4th Street, Suite 750, Los Angeles, California 90013.
Applications which do not include all required information and exhibits will not be processed.
THE CFL APPLICATION
References to exhibits in these instructions pertain to specific documents that must be submitted with the CFL application. The headings used in these instructions correspond to the application item numbers and exhibit letters in the CFL application.
COVER PAGE OF APPLICATION:
Check one box only to reflect the type of license for which you are applying, either "Lender" or "Broker" or "Both." Do not check more than one box.
ITEM NUMBER 1 OF APPLICATION:
Provide the applicant's legal name. For individuals (sole proprietors), list first, middle and last name. If a sole proprietor applicant has no middle name, indicate, e.g., "John [no middle name] Smith."
Note: Some foreign entities are required by the California Secretary of State's office to use an assumed name for all business they conduct in California. Such entities should provide that assumed name as the "Name of Applicant" and may only use that name. Such entities are not permitted to use a fictitious business name.
An applicant who intends to conduct CFL business under a fictitious business name that is different from its legal name should list the fictitious business name here. Enter the name exactly as it appears on the Fictitious Business Name Statement as filed with the county clerk. The fictitious business name must be provided in addition to the legal name. Applicants who intend to conduct business under a fictitious business name are required to comply with the rules governing the filing of a fictitious business name as set forth in the Business and Professions Code, beginning at section 17900.
Provide the name of the county in which the fictitious business name is filed. The fictitious business name must be filed in the county of the applicant's main office address.
ITEM NUMBER 2 OF APPLICATION:
Applicant is Organized and Will Do Business As:
Check the appropriate box to indicate the organizational form of the applicant.
ITEM NUMBER 3 OF APPLICATION:
Applicant's Licensed Place of Business:
Provide the applicant's full proposed place of CFL business, including number and street, city, county, state, and zip code. An additional CFL license is required for each additional business location.
ITEM NUMBER 4 OF APPLICATION (Sole Proprietor Applicants ONLY):
This item is to be completed only by applicants who are sole proprietors and not organized as any other form of business.
List the sole proprietor's full first, middle, and last name. If the applicant has no middle name, indicate, e.g., "John [no middle name] Smith."
Provide the full name, address, telephone number, and e-mail address of all managers as "person(s) who will be in charge of the place of business." "Managers" are persons with authority to manage the operations of the organization in California.
Provide the name and address of the applicant's agent for service of process in California. Provide this information if the applicant has an agent in California who is authorized to accept service on its behalf. As an example, it is common for persons to authorize their attorney to accept service of process on their behalf. Indicate if there is no authorized agent for service of process in California by stating "none".
ITEM NUMBER 5 OF APPLICATION (Partnership Applicants ONLY):
This item of the application must be completed only by applicants organized as a general or limited partnership.
Include the full date (month, day, and year) and the state where the partnership was organized.
Provide the requested information for all general partners and indicate if the general partner is a managing general partner by checking the box.
Provide the full name, address, telephone number, and e-mail address of all managers as "person(s) who will be in charge of the place of business." "Managers" are persons with authority to manage the operations of the organization in California.
List the full name of any other person with direct involvement in the applicant's proposed activities under the CFL license in 5.d. and any person that owns or controls, directly or indirectly, 10 percent or more of the outstanding interests of the applicant in 5.e. This includes any entity owning 10 percent or more of the outstanding interests of the applicant.
Provide the name and address of the applicant's agent for service of process in California. Provide this information if the applicant has an agent in California who is authorized to accept service on its behalf. For example, it is common for persons to authorize their attorney to accept service of process on their behalf. Indicate if there is no authorized agent for service of process in California by stating "none".
ITEM NUMBER 6 OF APPLICATION (Corporations and Other Business Entities):
Complete this item of the application only if the applicant is applying as a corporation, limited liability company, joint venture, association, joint stock company, trust, unincorporated organization, government, or political subdivision of a government.
Include the full date (month, day, year) of organization and the state where the applicant was organized.
List the full name of each of the officers, directors, managers, and trustees.
Provide the full name, address, telephone number, and e-mail address of all managers as "person(s) who will be in charge of the place of business." "Managers" are persons with authority to manage the operations of the organization in California.
List the full name of any other person with direct responsibility for the applicant's proposed activities under the CFL license in 6.d. and any other person that owns or controls, directly or indirectly, 10 percent or more of the outstanding equity securities of the applicant in Item 6.e. This includes any entity owning 10 percent or more of the outstanding equity securities of the applicant.
ITEM NUMBER 7 OF APPLICATION:
Regulatory or Other Action:
Under Financial Code section 22109, paragraphs (a)(2) and (3), the Commissioner of Financial Protection and Innovation may deny an application for a finance lender or broker license if the applicant or individuals(s) or entity(s) required to be disclosed in response to Items 4 through 6 above ("disclosed person") has been convicted of a crime or committed an act involving dishonesty, fraud, or deceit within the last 10 years, or if the applicant or disclosed person has violated the CFL or other similar regulatory scheme at any time. Describe, if applicable, by providing the information requested. Attach a copy of each action.
ITEM NUMBER 8 OF APPLICATION:
Other Business at Location:
Financial Code section 22154 requires written authorization from the Commissioner of Financial Protection and Innovation to conduct non-CFL business from a CFL-licensed location. Check the appropriate box. Describe, if applicable, any other business that will be conducted from the same location as the CFL-licensed business in sufficient detail that will allow the Commissioner of Financial Protection and Innovation to find that the character of the other business is such that the granting of authority to conduct other business at a CFL-licensed location would not facilitate evasions of the CFL or its rules and regulations. If none, so state.
ITEM NUMBER 9 OF APPLICATION:
Bonding Agent:
Provide the name, address, and telephone number of the bonding agent that the Department can contact regarding the applicant's surety bond.
ITEM NUMBER 10 OF APPLICATION:
This item of the application requires the applicant to provide basic information regarding its proposed activities. Check the appropriate boxes to indicate the type of collateral that will be securing the loans that you are making or brokering and indicate the corresponding minimum dollar amount of the loans made or brokered. Check all boxes that are applicable. There is a statutory minimum of $5,000 or more for commercial purpose loans and consumer loans secured by real estate. Commercial purpose loans less than $5,000 are treated statutorily as consumer purpose loans.
Provide a business plan that describes how the applicant plans to conduct business under the CFL license. Include any information necessary for the Commissioner of Financial Protection and Innovation to understand the type of business that the applicant plans to conduct under this license.
ITEM NUMBER 11 OF APPLICATION:
Qualification of Securities:
Check the appropriate box to indicate whether the applicant's offer and sale of securities have been qualified in California. Under the Corporate Securities Law of 1968, companies, individuals or other entities that offer and sell securities including common stock, debt, limited partnership interests or limited liability company membership interests, employee stock options, etc., in California must claim an exemption or qualify the offering by filing an application. If exempt, the applicant must have the appropriate limited/small offering exemption notice on file with the Department. Please contact the Department of Financial Protection and Innovation at 1-866-275-2677 for further information.
ITEM NUMBER 12 OF APPLICATION:
Designated Department of Financial Protection and Innovation Email Account:
Provide a designated email account to receive communications from the Department of Financial Protection and Innovation. Applicants must establish and maintain an email account designated for communications with the Department of Financial Protection and Innovation. In addition to identifying the email account in this application, an applicant must register online and designate the email address through the DFPI Self Service Portal at https://docqnet.dfpi.ca.gov/. The email account must conform to the following parameters:
EXHIBITS
EXHIBIT A:
Balance Sheet
Exhibit A requires each applicant (i.e., the person identified as "Name of Applicant" in Item Number 1) to submit a financial statement in the form of a balance sheet prepared according to generally accepted accounting principles that is dated no more than 90 days before the date that the application is filed with the Department. For example, if the applicant is a corporation, then submit a balance sheet for the corporation. If the applicant is a sole proprietor, then submit a personal balance sheet. Label the balance sheet as Exhibit A.
The applicant must meet and maintain a minimum net worth of $25,000 at all times. (Financial Code section 22104.) If the applicant does not meet this net worth requirement as evidenced by the balance sheet submitted with the application, then the application will not be approved. Applicants needing assistance should consult an accountant.
EXHIBIT B:
Surety Bond
Provide the original surety bond, including riders and endorsements, in the amount of $25,000. A bond form and instructions are enclosed.
To complete the bond form:
EXHIBIT C:
Statement of Identity and Questionnaire
Each individual (natural person) named in Item Numbers 4, 5, and 6 of the application must complete a Statement of Identity and Questionnaire. Submit the Statement of Identity and Questionnaire with the fingerprint information and the cost of fingerprint processing (discussed below).
The 10-year employment and residence histories in the Statement of Identity and Questionnaire must be complete and accurate. Attach copies of all pertinent court and other documents requested. The Statement of Identity and Questionnaire must be notarized if executed outside the State of California.
If an entity owns or controls 10 percent or more of the outstanding interests or outstanding equity securities of the applicant or licensee, a Statement of Identity and Questionnaire and fingerprints need not be submitted for each officer, director, general partner, or managing member of the owner, unless that individual has the power to direct the management or policies of the applicant's lending activities in this state.
Fingerprints
All individuals named in Item Numbers 4, 5, and 6 of the application must submit fingerprints and related information to the Department of Financial Protection and Innovation with the application, for the purposes of conducting a criminal history background check. (Financial Code section 22101.5.) Applicants must pay for the cost of processing the fingerprints.
Instructions for In-State Individuals Required to Submit Fingerprints:
Each individual who resides in California must complete a "Request for Live Scan Service" form. The triplicate form can be printed from the Department of Financial Protection and Innovation's website at www.dfpi.ca.gov. The individuals must take the three-part form to a live scan location to have their fingerprints taken by the operator and submitted electronically to the California Department of Justice for processing. The applicant must pay the fees charged by the California Department of Justice for processing the fingerprints directly to the live scan operator. The Attorney General's website at https://oag.ca.gov/fingerprints has current information concerning the Department of Justice's fees and the location of live scan terminals. You may also call the Department of Financial Protection and Innovation at 1-866-275-2677 for information concerning the location of live scan terminals. Submit the "Requesting Agency Copy" of the "Request for Live Scan Service" form and a processing fee of $20 per individual for live scan submission with the CFL application and the Statement of Identity and Questionnaire to the Department of Financial Protection and Innovation. Make the check for the fingerprint processing fees payable to the Department of Financial Protection and Innovation.
Instructions for Out-of-State Individuals Required to Submit Fingerprints:
Individuals residing outside of California are encouraged to come to California, if practical, to have their fingerprints taken and submitted electronically through California's Live Scan process, to significantly decrease the processing time. However, an out-of-state individual may provide fingerprint images to the Department of Financial Protection and Innovation on fingerprint cards. Call the Department of Financial Protection and Innovation at 1-866-275-2677 to obtain fingerprint cards. The Department of Financial Protection and Innovation will mail the fingerprint cards to you. The fee to process the fingerprint card is $86 per individual, which includes the Department of Financial Protection and Innovation's processing fee of $20 and the Department of Justice's processing fee of $66. Make the check for all fees payable to the Department of Financial Protection and Innovation. Submit the fingerprint cards, the fees, and the Statement of Identity and Questionnaire with the CFL application to the Department of Financial Protection and Innovation.
EXHIBIT D (Sole Proprietor Applicants ONLY):
Proof of Legal Presence
Sole proprietor applicants must complete and submit the "Statement of Citizenship, Alienage, and Immigration Status for Application of Department of Financial Protection and Innovation License or Certificate" in Exhibit D. Include copies of the acceptable proof of citizenship as outlined in List A of the Statement of Citizenship, Alienage, and Immigration Status.
Complete this form and submit proof of your citizenship only if applying for the license as a sole proprietor. Officers of corporations, limited liability companies or partnerships are not required to complete this form.
EXHIBIT E:
Authorization for Disclosure of Financial Records
Exhibit E is the "Customer Authorization for Disclosure of Financial Records". Submit this form as part of the application package. The form must be signed by an individual named in Item Numbers 4, 5, or 6 of the application who is authorized to sign on behalf of the applicant.
EXHIBIT F:
Fictitious Business Name Statement
Submit a copy of the current Fictitious Business Name Statement with the "filed stamp" from the county clerk's office. The applicant's name must appear as a registrant on the Fictitious Business Name Statement. Label this document as Exhibit F.
EXHIBIT G: All Corporate Applicants Incorporated in Any State
Corporations must submit an ORIGINAL certificate of qualification or good standing from the Secretary of State or other authority of the applicant's state of incorporation. The name on the certificate must match the name listed in Item Number 1 of the application. The certificate must also indicate the original date of incorporation. Label this document as Exhibit G.
EXHIBIT H (Foreign Corporations ONLY):
Additional Requirements for Applicants Incorporated in States Other Than California
Applicants incorporated OUTSIDE the State of California must submit an original certificate of qualification or good standing issued by the California Secretary of State, in addition to the document required in Exhibit G.
Foreign corporations must register and qualify the corporation to conduct business in the State of California as a foreign corporation through the California Secretary of State. The name on the certificate must match the name listed in Item Number 1 of the application. Label the document as Exhibit H.
EXHIBIT I: All General Partnership Applicants Organized in Any State Partnership Agreement
Provide a copy of the original partnership agreement. The agreement must indicate the original date of organization. Label the document as Exhibit I.
EXHIBIT J: Applicants Organized in Any State as a Limited Partnership or Limited Liability Company
Limited partnerships and limited liability companies must submit an ORIGINAL certificate of qualification or good standing from the Secretary of State or other authority of the applicant's state of organization. The name on the certificate must match the name in Item Number 1 of the application. The certificate must also indicate the original date of organization. Label the document as Exhibit J.
EXHIBIT K (Foreign Business Entities ONLY):
Additional Requirements for Applicants Organized as a Limited Partnership or Limited Liability Company in States Other Than California
A foreign limited partnership or foreign limited liability company must also register and qualify to conduct business in the State of California and provide an original certificate of qualification or good standing from the California Secretary of State. The name on the certificate must match the name listed in Item Number 1 of the application. Label the document as Exhibit K.
EXHIBIT L:
Social Security Number or Federal Taxpayer Identification Number
Individuals (sole proprietors) applying for a license must provide their social security number. Corporations, partnerships, limited liability companies and other business entities, except sole proprietorships, applying for a license must provide the federal taxpayer identification number. The Department of Financial Protection and Innovation must collect social security numbers from all applicants under Family Code section 17520, and social security numbers or federal taxpayer identification numbers under Business and Professions Code section 494.5. The social security number or federal taxpayer identification number is used to match the information to the names on the list provided by the Department of Child Support Services under Family Code section 17520, and the lists of tax delinquencies provided by the State Board of Equalization and the Franchise Tax Board under Business and Professions Code section 494.5. Any disclosed social security numbers and federal taxpayer identification numbers in the completed application will be considered confidential information, and will be filed and maintained as part of the confidential records not subject to public inspection. Refer to Commissioner's Release 2-G for further information concerning privacy protection of personal information.
EXHIBIT M:
Organizational Chart
If the applicant is owned by another entity(s) or individual(s), or is an affiliate of or affiliated with another entity, provide an organizational chart identifying each entity or individual that owns the applicant or with whom the applicant is affiliated. Identify each entity and individual's percentage of ownership in the applicant. Label the organizational chart as Exhibit M.
For purposes of this exhibit, an applicant is an "affiliate" of, or an applicant is "affiliated" with, another entity if the applicant directly, or indirectly through one or more intermediaries, controls, is controlled by or is under common control with the other entity, and an affiliate includes subsidiaries of the applicant.
On or as an attachment to the organizational chart, identify by name and title the directors, officers, managing members, and partners, as applicable, for the applicant and each direct owner of 10 percent or more of the applicant.
EXECUTION SECTION:
Complete the required information. The Execution Section must be signed by the applicant in the case of a sole proprietor applicant or, for other types of applicants, by an individual who is named in Item Numbers 4, 5, or 6 of the application and who is authorized to sign on behalf of the applicant. By signing the application, the applicant agrees with the representations listed and agrees to appoint the Commissioner of Financial Protection and Innovation to receive service of process on behalf of the applicant.
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CFL Application Checklist |
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Application Question Number or Exhibit Letter |
Sole Proprietor |
Domestic Corporation |
Foreign Corporation |
Domestic LLC |
Foreign LLC |
Domestic General or Limited Partnership |
Foreign General or Limited Partnership |
|
1. Name |
X |
X |
X |
X |
X |
X |
X |
|
2. Business Type |
X |
X |
X |
X |
X |
X |
X |
|
3. Place of Business |
X |
X |
X |
X |
X |
X |
X |
|
4. Sole Proprietor Licensee Information |
X | ||||||
|
5. Partnership X X Licensee Information | |||||||
|
6. Corporation & Other Licensee Information |
X |
X |
X |
X | |||
|
7. Regulatory or Other Action |
X |
X |
X |
X |
X |
X |
X |
|
8. Other Business at Location |
X |
X |
X |
X |
X |
X |
X |
|
9. Bonding Agent |
X |
X |
X |
X |
X |
X |
X |
|
10. Proposed Activities |
X |
X |
X |
X |
X |
X |
X |
|
11. Qualification of Securities |
X |
X |
X |
X |
X |
X |
X |
|
12. Designated email account |
X |
X |
X |
X |
X |
X |
X |
|
A. Balance Sheet |
X |
X |
X |
X |
X |
X |
X |
|
B. Surety Bond |
X |
X |
X |
X |
X |
X |
X |
|
C. Statement of Identity |
X |
X |
X |
X |
X |
X |
X |
|
D. Sole Proprietor Licensee Information |
X | ||||||
|
E. Authorization for Disclosure |
X |
X |
X |
X |
X |
X |
X |
|
F. Fictitious Business Name |
X |
X |
X |
X |
X |
X |
X |
|
G. Corporation Licensee Information |
X |
X | |||||
|
H. Foreign Corporation Licensee Information |
X | ||||||
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I. General Partnership Licensee Information |
GP ONLY X |
GP ONLY X |
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J. Limited Partnership & LLC Licensee Information |
X |
X |
LP ONLY X |
LP ONLY X |
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K. Foreign Limited Partnership & LLC Licensee Information |
X |
LP ONLY X |
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L. Social Security Number or Federal Taxpayer Identification Number |
X |
X |
X |
X |
X |
X |
X |
|
M. Organizational Chart |
X |
X |
X |
X |
X |
X |
|
|
Execution Section |
X |
X |
X |
X |
X |
X |
X |
(Department of Financial Protection and Innovation Use Only)
DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATION
| Fee Paid $ ___________________________ | File No. ___________________________ | |
| Receipt No. ___________________________ | ||
STATE OF CALIFORNIA DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATIONAPPLICATION FOR A LICENSE UNDER THE CALIFORNIA FINANCING LAW
APPLICATION FOR A LICENSE AS A: [ ] LENDER [ ] BROKER [ ] BOTH
___________________________
The application must be accompanied by a nonrefundable application fee of $200, a nonrefundable investigation fee of $100, and nonrefundable fingerprint processing fees (Departments of Financial Protection and Innovation and Justice). The application (together with the fees payable to the Department of Financial Protection and Innovation) must be filed in the Los Angeles office of the Department of Financial Protection and Innovation, located at 320 West 4th Street, Suite 750, Los Angeles, CA 90013.
___________________________
___________________________
___________________________
___________________________
[] an individual (a sole proprietor)
[] a general partnership
[] a limited partnership
[] a corporation
[] a limited liability company
[] other (please specify such as joint venture, association, joint stock company, trust, unincorporated organization, government, or political subdivision of a government):
___________________________
| ___________________________ | |||||
| (Number and Street) | (City) | (County) | (State) | (Zip) | |
___________________________
(Name)
| ___________________________ | ||
| (Name) | (Telephone Number) (E-mail Address) | |
| ___________________________ | ||||
| (Number and Street) | (City) | (State) | (Zip) | |
| ___________________________ | ||||
| (Name) | ||||
| ___________________________ | ||||
| (Number and Street) | (City) | (State) | (Zip) | |
| ___________________________ | Check here if a Managing Partner [] | |||
| (Name) | ||||
| ____________________________________________________ | ||||
| (Number and Street) | (City) | (State) | (Zip) | |
| ________________________________________________________ | |||||
| (Name) | (Telephone Number) (E-mail Address) | ||||
| _________________________________________________________ | |||||
| (Number and Street) | (City) | (State) | (Zip) | ||
|
___________________________ |
___________________________ |
||
|
(Name) |
(Name) |
|
___________________________ |
___________________________ |
||
|
(Name) |
(Name) |
| ___________________________ | ||||
| (Name) | ||||
| ___________________________ | ||||
| (Number and Street) | (City) | (State) | (Zip) | |
|
President/Chief Executive Officer: |
Executive Vice President/Vice President: |
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___________________________ |
________________________________________ |
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(Name) |
(Name) |
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Secretary: |
Treasurer/Chief Financial Officer: |
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___________________________ |
________________________________________ |
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(Name) |
(Name) |
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Directors: | |||
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___________________________ |
________________________________________ |
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(Name) |
(Name) |
Manager(s) [i.e., a managing member of an association, or a manager appointed or elected by the members of a limited liability company]:
|
___________________________ |
___________________________ |
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|
(Name) |
(Name) |
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Trustee(s): | |||
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___________________________ |
___________________________ |
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(Name) |
(Name) |
| ___________________________________________ | |||||
| (Name) | (Telephone Number) | (E-mail Address) | |||
| ___________________________________________ | |||||
| (Number and Street) | (City) | (State) | (Zip) | ||
|
___________________________ |
___________________________ |
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|
(Name) |
(Name) |
|
___________________________ |
___________________________ |
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|
(Name) |
(Name) |
| [] Yes | [] No |
If yes, provide copies of all pertinent court documents relating to the action and complete the following:
| Type of Action: | [] Administrative | [] Criminal | [] Civil |
Name of Regulator, Agency or Plaintiff: ___________________________________
Nature of Charges: _____________________________________________
Type of Resolution: ________________________________________
Date of Resolution or Settlement: ___________________________________
| [] Yes | [] No |
If yes, provide copies of all pertinent court documents relating to the action and complete the following:
| Type of Action: | [] Administrative | [] Civil |
Name of Regulator, Agency, or Plaintiff: ___________________________________
Nature of Charges: _____________________________________________
Type of Resolution: _____________________________________________
Date of Resolution or Settlement: ___________________________________
| [] Yes | [] No |
If yes, describe any business being conducted or planned to be conducted on the applicant's premises in sufficient detail that will allow the Commissioner of Financial Protection and Innovation to find that the character of the other business is such that the granting of authority to conduct other business at a licensed location would not facilitate evasions of the California Financing Law or its rules and regulations. If the Commissioner of Financial Protection and Innovation's authorization is not required because the products or services are of a supervised financial institution affiliated with the applicant, so indicate.
___________________________
___________________________
___________________________
___________________________
___________________________
|
__________________________________________________________ |
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|
(Name of Bonding Agent) |
(Telephone Number) |
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|
__________________________________________________________ |
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|
(Number and Street) |
(City) |
(State) |
(Zip) |
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|
COMMERCIAL LOANS |
CONSUMER LOANS |
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|
Collateral Type (check [TICK] all that apply) |
Minimum Loan Amount |
Collateral Type (check [TICK] all that apply) |
Minimum Loan Amount |
|
|
[] Real Property |
$ |
[] Real Property |
$ |
|
|
[] Personal Property |
$ |
[] Personal Property |
$ |
|
|
[] Unsecured |
$ |
[] Unsecured |
$ |
|
Note: The minimum loan amount for a commercial purpose loan is $5,000.00. A commercial purpose loan less than $5,000.00 is treated statutorily as a consumer purpose loan. A consumer purpose loan collateralized by real property must be $5,000.00 or more.
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
| [] Yes | [] No |
If no, check as applicable:
[] Applicant is exempt from qualification and has filed any applicable notice of exemption with the Department.
[] Applicant has never offered or sold its securities in California or to a California resident.
EXHIBIT A. Provide a balance sheet of the applicant prepared in accordance with generally accepted accounting principles and dated no more than 90 days prior to the date this application is filed. Label the balance sheet as Exhibit A.
EXHIBIT B. Provide the original surety bond, including riders and endorsements, in the amount of $25,000. The instructions and bond form are enclosed.
EXHIBIT C. Provide for each individual (natural person) named in Items 4, 5, and 6, a Statement of Identity and Questionnaire, along with fingerprint information and the cost of fingerprint processing. The Statement of Identity and Questionnaire form is enclosed.
EXHIBIT D. SOLE PROPRIETOR ONLY: Complete the enclosed form entitled "Statement of Citizenship, Alienage, and Immigration Status for Application of Department of Financial Protection and Innovation License or Certificate."
EXHIBIT E. Complete the enclosed form entitled "Customer Authorization for Disclosure of Financial Records."
EXHIBIT F. Provide a copy of the current Fictitious Business Name Statement filed with the county clerk. Label the document as Exhibit F.
EXHIBIT G. ALL CORPORATE APPLICANTS INCORPORATED IN ANY STATE: Submit an original certificate of good standing or qualification executed by the Secretary of State of your state of incorporation, or other proper authority showing that the applicant is authorized to transact business in that state. The certificate must indicate the original date of incorporation. Label the document as Exhibit G.
EXHIBIT H. ADDITIONAL REQUIREMENT FOR APPLICANTS INCORPORATED IN STATES OTHER THAN CALIFORNIA (FOREIGN CORPORATION) ONLY: Submit an original certificate of good standing or qualification executed by the California Secretary of State showing that the applicant is qualified to do business in California. Label the document as Exhibit H.
EXHIBIT I. GENERAL PARTNERSHIP APPLICANTS ONLY: Submit a copy of the original partnership agreement. Label the document as Exhibit I.
EXHIBIT J. APPLICANTS ORGANIZED IN ANY STATE AS A LIMITED PARTNERSHIP OR LIMITED LIABILITY COMPANY: Submit an original certificate of good standing or qualification executed by the Secretary of State of your state of organization, or other proper authority showing that the applicant is authorized to transact business in that state. The certificate must indicate the original date of organization. Label the document as Exhibit J.
EXHIBIT K. ADDITIONAL REQUIREMENT FOR APPLICANTS ORGANIZED AS A LIMITED PARTNERSHIP OR LIMITED LIABILITY COMPANY IN STATES OTHER THAN CALIFORNIA (FOREIGN BUSINESS ENTITY) ONLY: Submit an original certificate of good standing or qualification executed by the California Secretary of State showing that the applicant is qualified to do business in California. Label the document as Exhibit K.
EXHIBIT L. SOCIAL SECURITY NUMBER OR FEDERAL TAXPAYER IDENTIFICATION NUMBER: Provide the social security number if the applicant is an individual (sole proprietor) or the federal taxpayer identification number if the applicant is a business entity other than a sole proprietorship. Label the document as Exhibit L.
EXHIBIT M. ORGANIZATIONAL CHART: Provide an organizational chart with ownership percentages included. Identify by name and title the directors, officers, managing members, and partners, as applicable, for the applicant and each direct owner of 10 percent or more of the applicant. Label this document as Exhibit M.
EXECUTION SECTION: Complete and sign the enclosed declaration.
EXECUTION SECTION
In the matter of the Application for a License under the California Financing Law, I, the undersigned, authorized to act on behalf of the applicant, declare that the following statements are true and correct:
| __________________________________ | ||||
| (Name) | ||||
| _______________________________________ | ||||
| (Number and Street) | (City) | (State) | (Zip Code) | |
Indicate the name, title, address, telephone number, and e-mail address of the person who should be contacted for information regarding this application. The license will also be sent to this person unless otherwise instructed.
| Attention: ___________________ | ||||
| (Name) | (Title) | (Telephone Number) | ||
|
___________________________________________________________ |
||||
|
(Number and Street) |
(City) |
(State) |
(Zip Code) |
|
|
__________________________________________________________ |
||||
|
(Email Address) |
||||
WHEREFORE, applicant requests that a license be issued by the Commissioner of Financial Protection and Innovation authorizing applicant to engage in business under the California Financing Law within the State of California.
The applicant has duly caused this application to be signed on its behalf by the undersigned, thereunto duly authorized. The undersigned, on behalf of the applicant, acknowledges that this application and all exhibits thereto which are not designated as confidential are subject to public inspection pursuant to California Code of Regulations, title 10, section 250.9.1. A request for confidentiality of certain documents may be requested pursuant to section 250.10 of the rules. If a request for confidential treatment is granted (or denied), the person making such request will be notified in writing.
The undersigned also acknowledges on behalf of the applicant that the State Board of Equalization and the Franchise Tax Board are authorized to share taxpayer information with the Department of Financial Protection and Innovation, and in the event the state tax obligation is not paid by a licensee after a license is issued, the Department of Financial Protection and Innovation may be required to suspend the license (Bus. & Prof. Code, §§31, 494.5).
I declare under penalty of perjury under the laws of the State of California that I have read the foregoing application, including all Exhibits attached thereto, or filed therewith, and know the contents thereof, and that the statements therein are true and correct.
The signor of this declaration must be named in either Section 4, 5, or 6 of this application.
|
___________________________ |
||
|
(Applicant) |
||
|
Executed at ___________________________ |
___________________________ |
|
|
(City, County, and State) |
(Signature of Declarant) |
|
|
Date ___________________________ |
___________________________ |
|
|
(Typed Name of Declarant) |
||
|
___________________________ |
||
|
(Title) |
1422 - CFLL Application Long Form
STATE OF CALIFORNIA DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATIONINSTRUCTIONS FOR FILING OF SURETY BOND EXHIBIT B
This exhibit contains the approved format for the Surety Bond as required by Financial Code section 22112. Every licensee is required to obtain and maintain a surety bond.
The original surety bond must be filed with an application and must include all of the following:
BEFORE THE DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATION OF THE STATE OF CALIFORNIA EXHIBIT BBOND OF FINANCE LENDER, BROKER, OR PROGRAM ADMINISTRATOR FINANCIAL CODE SECTION 22112
Bond No. ____________________
KNOW ALL MEN BY THESE PRESENTS:
That we ___________________________________, as Principal, whose address for service is (Street Address, City, State and ZIP Code) ______________________________, and _________________________, a corporation, created, organized and existing under and by virtue of the laws of the State of _________________________ and an admitted Surety insurer authorized to transact a general Surety business in the State of California, as Surety whose address for service is (Street Address, City, State and ZIP Code) _____________________________________________, are held and firmly bound unto the Commissioner of Financial Protection and Innovation of the State of California, for the use thereof and for the use of any person or persons who may have a cause of action against the Principal under the provisions of the California Financing Law and all laws amendatory thereof and supplementary thereto now and hereafter enacted, in the total aggregate penal sum of _________________________ Dollars ($ ____________________) (see Fin. Code, §22112), lawful money of the United States of America, to be paid to the Commissioner of Financial Protection and Innovation of the State of California, or to any person or persons, for the use and benefit aforesaid, for which payment well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally firmly by these presents.
The condition of the above obligation is such that--
WHEREAS, The above-named Principal has made application to the Commissioner of Financial Protection and Innovation of the State of California for a license to engage in business under and pursuant to the provisions of the California Financing Law, and is required under the provisions of the California Financing Law to furnish a bond in the sum above named, conditioned as herein set forth:
NOW, THEREFORE, The Principal, and any and all agents and employees representing the Principal, shall faithfully conform to and abide by the provisions of the California Financing Law and all laws amendatory thereof and supplementary thereto now and hereafter enacted, and of all rules and regulations lawfully made by the Commissioner of Financial Protection and Innovation of the State of California under the California Financing Law and shall honestly and faithfully apply all funds received and shall faithfully and honestly perform all obligations and undertakings under the California Financing Law, and shall pay to the Commissioner of Financial Protection and Innovation of the State of California and to any person or persons, for the use and benefit aforesaid, any and all moneys which become due or owing the State or to any such person or persons from the Principal under and by virtue of the provisions of the California Financing Law.
This bond is subject to the following provisions:
___________________________________
Signature of Principal
___________________________________
Typed or Printed Name of Principal
___________________________________
Executed at (City and State)
I certify (or declare) under penalty of perjury under the laws of the State of California that I have executed the foregoing bond under an unrevoked power of Attorney.
Executed in ______________________________(City and State) on ____________________(Date)
___________________________________
Signature of Attorney-in-Fact
for Surety
___________________________________
Printed or typed name of Attorney-in-Fact for Surety
ALL OF THE ABOVE SIGNATURES MUST BE NOTARIZE
DDEPARTMENT OF FINANCIAL PROTECTION AND INNOVATION STATE OF CALIFORNIA EXHIBIT C
___________________________________
File Number, if any
___________________________________
Licensee (Company Name)
Insert Department of Financial Protection and Innovation file number, if any, and the name of the licensee (company) to which this Statement of Identity and Questionnaire relates.
STATEMENT OF IDENTITY AND QUESTIONNAIRE
|
Legal Full Name ___________________________ |
|||
|
First Name |
Middle Name |
Last Name |
|
|
(Do not use initials or nicknames) |
|||
Position to be filled in connection with the preparation of this questionnaire (e.g. Officer, Director, Manager, etc.).
__________________________________________________________________________
Sex ____________________ Hair ____________________ Eyes ____________________ Height ____________________ Weight____________________
| Bithdate ___________________________ | Birthplace ___________________________ | ||
| Social Security Number ___________________________ | California Driver's License Number | ||
| See Commissioner's Release 2-G regarding whether furnishing the social security number is mandatory or voluntary and for a description of the use made of that information. | (if none, so state) _________________________ | ||
| Residence | Business | ||
| Phone Number ___________________________ | Phone Number ___________________________ | ||
| Hours of Employment | |||
| Address ___________________________ | (e.g., 8:00 a.m. to 5:00 p.m.) ___________________________ | ||
| From | To | Street | City | State | Zip Code |
| Present |
Attach separate schedule if space is not adequate.
EXHIBIT C (FS 512 SIQ)
| Insert Full Name of Individual: _______________ | Insert Licensee (Company Name): ____________ |
| From | To | Employer Name and Address | Occuption and Duties |
| Present |
Attach separate schedule if space is not adequate.
Have you ever been named in any order, judgment or decree of any court or any governmental agency or administrator, temporarily or permanently restraining or enjoining you from engaging in or continuing any conduct, practice or employment?
| [] Yes | [] No |
If the answer is "Yes", give details:
___________________________
___________________________
Attach a copy of any order, judgment or decree.
| [] Yes | [] No |
If the answer is "Yes", give details:
___________________________
___________________________
| [] Yes | [] No |
Financial business means securities broker-dealer or agent, investment adviser or investment adviser representative, financial planner, insurance agent, escrow agent, finance lender or broker, mortgage lender or servicer, real estate broker, payday lender, financial institution, bill payer or prorater, commodity sales person, certified public accountant, or any other business involving investment or financial transactions.
If the answer is "Yes", describe in the chart below the following for each license:
| License Period | License Number | Type of License/Business | Name and Address of Licensing Entity |
| From: | |||
| To: | |||
| From: | |||
| To: |
Attach separate schedule if space is not adequate.
EXHIBIT C (FS 512 SIQ)
| Insert Full Name of Individual: ___________________________ | Insert Licensee (Company Name): ___________________________ |
| [] Yes | [] No |
If the answer is "Yes", give details:
___________________________
___________________________
Attach a copy of any settlement.
"Convicted" includes a verdict of guilty by judge or jury, a plea of guilty or of nolo contendere or a forfeiture of bail. All convictions must be disclosed even if the plea or verdict was thereafter set aside and the charges against you dismissed or expunged or if you have been pardoned. Convictions occurring while you were a minor must be disclosed unless the record of conviction has been sealed under section 1203.45 of the California Penal Code or section 781 of the California Welfare and Institutions Code.
| [] Yes | [] No |
If the answer is "Yes", give details:
___________________________
___________________________
Attach a copy of any order, judgment or decree. If a conviction was entered under section 23152(a) of the Vehicle Code, attach a written declaration stating whether drugs were involved.
| [] Yes | [] No |
If the answer is "Yes", complete the following:
Date of suit ______________________________ Location of court ______________________________
___________________________
Nature of suit
Attach a copy of any order, judgment or decree.
| [] Yes | [] No |
If the answer is "Yes", give date, title of case, location of bankruptcy filing:
___________________________
___________________________
___________________________
| [] Yes | [] No |
If the answer is "Yes", give details:
___________________________
___________________________
| [] Yes | [] No |
| Insert Full Name of Individual: ___________________________ | Insert Licensee (Company Name): ___________________________ |
If so, explain. Change in name through marriage or court order and exact date of each name change must be listed.
|
Prior Name |
Date of Name Change | |||
|
___________________________ |
___________________________ | |||
|
___________________________ |
___________________________ |
| [] Yes | [] No |
If the answer is "Yes", give details:
___________________________
___________________________
The following questions must be answered by all persons submitting this questionnaire in connection with an ESCROW AGENT'S LICENSE.
| [] Yes | [] No |
If the answer is "Yes", give details:
___________________________
___________________________
___________________________
This statement will be considered confidential information and will be filed and maintained as part of the confidential records not subject to public inspection.
VERIFICATION
I, the undersigned, state that I am the person named in the foregoing Statement of Identity and Questionnaire; that I have read and signed said Statement of Identity and Questionnaire and know the contents thereof, including all exhibits attached thereto, and that the statements made therein, including any exhibits attached thereto, are true, and that I have not omitted any information needed to make this document true.
This verification may be made either before a Notary Public or as a declaration under penalty of perjury. This form MUST be executed before a Notary Public if it is executed OUTSIDE the State of California.
I certify/declare under penalty of perjury that the foregoing is true and correct.
Executed at ____________________
(City)
______________________________
| (County) | (State) |
this __________ day of ____________________, 20___.
______________________________
(Print Name)
______________________________
(Signature of Individual)
State of ______________________________)
County of ______________________________)
Date __________, 20___ at ____________________
______________________________
(Signature of Individual)
Subscribed and sworn to before me
____________________, 20 ___
______________________________
Notary Public in and for said County and State
STATE OF CALIFORNIA
DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATION
INSTRUCTIONS FOR CUSTOMER AUTHORIZATION FOR DISCLOSURE OF FINANCIAL RECORDS FORM
Enclosed is a Customer Authorization for Disclosure of Financial Records form. The Commissioner of Financial Protection and Innovation is authorized to require such authorization from licensees and other persons pursuant to the authority cited in Financial Code section 22156.
The form must be properly executed and submitted to the Department of Financial Protection and Innovation.
If additional authorization forms are needed, they may be obtained from any office of the Department of Financial Protection and Innovation or the Department's website (www.dfpi.ca.gov), or an accurate copy of the form may be used by applicant.
STATE OF CALIFORNIA
DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATION
CUSTOMER AUTHORIZATION FOR DISCLOSURE OF FINANCIAL RECORDS EXHIBIT E
Pursuant to Financial Code section 22156 and Government Code section 7473, any financial institution, wherever situated, possessing financial records of
___________________________
(Name of Applicant as appears on Application)
Licensed under the CALIFORNIA FINANCING LAW
is hereby authorized to disclose to the California Department of Financial Protection and Innovation records of the above-named business licensed under the above-described Act, whether such records relate to accounts which have been closed, accounts which are currently maintained, or accounts which are hereafter established.
This authorization is effective as of the date of execution and shall remain effective until five years after the expiration or revocation of the above- named business licensed under the above-described Act, including renewals of such license.
This authorization may not be revoked.
The terms used in this authorization shall have the definitions contained in the California Right to Financial Privacy Act (Gov. Code, § 7460 et seq.), and the California Financing Law (Fin. Code, §22000 et seq.).
The above-named licensee has duly caused this authorization to be signed on its behalf by the undersigned, thereunto duly authorized.
Executed on ________________________________________ at ________________________________________
(Provide date and city where executed)
________________________________________
(Name of Licensee)
By ________________________________________
(Signature)
________________________________________
(Title)
EXHIBIT E
1. New
section filed 3-18-2002 as an emergency; operative 3-18-2002 (Register 2002,
No. 12). A Certificate of Compliance must be transmitted to OAL by 7-16-2002 or
emergency language will be repealed by operation of law on the following
day.
2. New section refiled 7-10-2002 as an emergency; operative
7-15-2002 (Register 2002, No. 28). A Certificate of Compliance must be
transmitted to OAL by 11-12-2002 or emergency language will be repealed by
operation of law on the following day.
3. Certificate of Compliance
as to 7-10-2002 order, including amendments, transmitted to OAL 10-30-2002 and
filed 12-16-2002 (Register 2002, No. 51).
4. Editorial correction
implementing amendments from 12-16-2002 order and amending HISTORY 3 (Register
2003, No. 20).
5. Amendment of section and new NOTE filed 11-7-2007;
operative 12-7-2007 (Register 2007, No. 45).
6. Amendment of
subsections (b) and (c) and amendment of NOTE filed 1-7-2014; operative
1-7-2014 pursuant to Government Code section
11343.4(b)(3)
(Register 2014, No. 2).
7. Amendment of section heading, section and
NOTE filed 8-5-2021; operative 10-1-2021 (Register 2021, No. 32). Transmission
deadline specified in Government Code section
11346.4(b)
extended 60 calendar days pursuant to Executive Order N-40-20 and an additional
60 calendar days pursuant to Executive Order N-71-20. Filing deadline specified
in Government Code section
11349.3(a)
extended 60 calendar days pursuant to Executive Order N-40-20 and an additional
60 calendar days pursuant to Executive Order
N-71-20.
Note: Authority cited: Section 22150, Financial Code. Reference: Sections 31 and 494.5, Business and Professions Code; Section 2106, Corporations Code; and Sections 331, 331.5, 22000, 22050, 22100, 22100.5, 22101, 22101.5, 22102, 22103, 22104, 22105, 22106, 22107, 22108, 22109, 22112, 22153, 22154, 22157 and 22159, Financial Code.
