California Code of Regulations › Title 10 - Investment › Chapter 3 - Commissioner of Financial Protection and Innovation › Subchapter 6 - California Financing Law › Article 2 - Applications › Section 1423 - Short Form Application for Licensees Seeking Additional Location License; Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except
				  as provided in section
				  1424 of these rules, the
				  application for a licensee seeking an additional location license pursuant to
				  Financial Code section
				  22102,
				  subdivision (b) shall be filed upon the form set forth in subdivision (b) of
				  this section. An applicant under this section must currently hold a valid
				  finance lender or broker license pursuant to Financial Code sections
				  22100 and
				  22101.
(b) An application for a licensee as set
				  forth in subdivision (a) shall be submitted to the Commissioner of Financial
				  Protection and Innovation on the following form:
STATE OF CALIFORNIA DEPARTMENT OF FINANCIAL
					 PROTECTION AND INNOVATION
INSTRUCTIONS FOR COMPLETING THE SHORT FORM
					 APPLICATION FOR A LICENSE UNDER THE CALIFORNIA FINANCING LAW
					 (CFL)
ASSISTANCE WITH THE APPLICATION
Refer to these instructions while completing the CFL short
					 form 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. Department 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 any attachments must be typewritten.
					 The signature must be original and not a copy. Attach additional sheets if you
					 need more space to complete an answer to any of the questions and label the
					 answers by the corresponding question number. Answer every question in the
					 application.
A CFL licensee seeking to engage in business at an
					 additional location must submit this application to the Commissioner of
					 Financial Protection and Innovation by certified mail, return receipt
					 requested, at least 10 days before engaging in business at the location.
The application must be accompanied by a nonrefundable
					 application fee of $200 and an investigation fee of $100. The application fee
					 and investigation fee are not refundable if the application is denied or
					 withdrawn.
Make the check payable to the Department of Financial
					 Protection and Innovation for the total amount of all fees. The application,
					 attachments, 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.
THE CFLL CFL SHORT FORM APPLICATION
The headings used in these instructions correspond to the
					 item numbers in the application.
ITEM NUMBER 1 OF APPLICATION:
Name of Applicant:
Provide the applicant's legal name. 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. These entities should provide
					 that assumed name as the "Name of Applicant" and may only use that name. These
					 entities are not permitted to use a fictitious business name.
Fictitious Business Name:
An applicant that intends to conduct CFL business under a
					 fictitious business name that is different from its legal name should provide
					 the fictitious business name here. Provide the name that appears on the
					 Fictitious Business Name Statement as filed with the county clerk.
The use of a fictitious business name is not permitted for
					 a new location unless the Department of Financial Protection and Innovation has
					 already approved the use of that name. If the fictitious business name has not
					 been approved by the Department of Financial Protection and Innovation,
					 approval of a new fictitious business name may be requested from the Department
					 of Financial Protection and Innovation by submitting under separate cover a
					 copy of the 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. This document should be forwarded along
					 with a written request to CFL Licensing Specialist, Department of Financial
					 Protection and Innovation, 320 West 4th Street, Suite 750, Los Angeles,
					 California 90013. 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 Business and Professions Code section
					 17900
					 et seq.
ITEM NUMBER 2 OF APPLICATION:
Applicant's Licensed Place of Business:
Provide the applicant's complete proposed place of CFL
					 business, including number and street, city, county, state, zip code, telephone
					 number, and fax number.
ITEM NUMBER 3 OF APPLICATION:
Individual in Charge of this Location:
Each office must have a person who is in charge. Provide
					 the full name of the individual who will be in charge of this location. If the
					 applicant has no middle name, indicate, e.g. "John [no middle name]
					 Smith."
Statement of Identity and
					 Questionnaire:
The individual named in Item Number 3 of the application
					 must complete and submit a Statement of Identity and Questionnaire. If a
					 Statement of Identity and Questionnaire has already been provided to the
					 Department for the individual named in Item Number 3, there is no need to
					 complete the form. The same individual cannot be in charge of multiple
					 locations, and each location must have an individual in charge.
The 10-year employment and residence history 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. Submit the Statement of Identity and Questionnaire with the
					 fingerprint information and the cost of fingerprint processing (discussed
					 below).
Fingerprints
Individual(s) named in Item Number 3 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. (Fin. Code, §
											22101.5.) Applicants must pay for
					 the cost of processing the fingerprints.
In-State Individuals:
Individuals named in Item Number 3 of the application who
					 reside 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 individual 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 will be required
					 to 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.
Out-of-State Individuals:
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
					 named in Item Number 3 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 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.
ITEM NUMBER 4 OF APPLICATION:
Applicant's Plan of Business:
Mark the appropriate box with either a "yes" or "no"
					 response to indicate if there has been any change in the plan of business of
					 making or brokering loans or other business that was previously submitted to
					 the Department of Financial Protection and Innovation. If "yes", explain the
					 change.
ITEM NUMBER 5 OF APPLICATION:
Applicant's License Number:
Provide the existing license number and address of at least
					 one other CFL license currently held by the applicant.
ITEM NUMBER 6 OF APPLICATION:
Responsible Officer or Compliance
					 Person:
Provide the name, title, address, email address, and
					 telephone number of the contact person to whom questions regarding the filing
					 of this application should be directed. The responsible officer or compliance
					 person must be from the main office of the company, and may not be a branch
					 manager.
EXHIBITS:
EXHIBIT A (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.
					 Label the document as Exhibit A.
The Department of Financial Protection and Innovation is
					 required to 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 B (Not Applicable)
EXHIBIT C (Statement of Identity and
					 Questionnaire):
Provide for the individual named in Item 3, a Statement of
					 Identity and Questionnaire. If applicable, provide fingerprint information and
					 the cost of fingerprint processing.
SIGNATURE SECTION:
Provide the required information. The Signature Section
					 must be signed by an officer who has previously completed and submitted a
					 Statement of Identity and Questionnaire to the Department of Financial
					 Protection and Innovation.
The application must be signed by the applicant if a sole
					 proprietor, by a general partner if a partnership, or by an authorized officer,
					 if a corporation. (Department of Financial Protection and Innovation Use
					 Only)
Fee Paid $ ______________________________Department of
					 Financial Protection and Innovation
Receipt No. ______________________________File No.
					 ______________________________
STATE OF CALIFORNIA DEPARTMENT OF FINANCIAL
					 PROTECTION AND INNOVATION
"SHORT FORM APPLICATION" FOR A LICENSE UNDER THE
					 CALIFORNIA FINANCING LAW FOR A LICENSEE CURRENTLY HOLDING ONE OR MORE
					 LICENSES
This application must be accompanied by a nonrefundable
					 application fee of $200 and a nonrefundable investigation fee of $100. (Fin.
					 Code, §
											22103.) The application (together
					 with the fees payable to the Department of Financial Protection and Innovation)
					 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, CA 90013.
A licensee seeking to engage in business at a new location
					 must submit this application to the Commissioner of Financial Protection and
					 Innovation by certified mail, return receipt requested, at least 10 days before
					 engaging in business at the new location.
A license issued pursuant to the California Financing Law
					 permits only employees to work under the license. Persons engaged in lending
					 that are not employees may need to obtain a license under the California
					 Financing Law. In addition, a license issued pursuant to the California
					 Financing Law does not permit a licensee to authorize locations operated by
					 persons other than employees of the licensee under some form of franchise or
					 license agreement (e.g., net branching).
1. Name of applicant:
				  ____________________________________________________________
Fictitious Business Name (FBN):
					 __________________________________________________
(FBN must already be on file with the Department. [Fin.
					 Code, §
												22102, subd. (e).])
(If the applicant seeks to do business under an FBN that
					 has not been previously approved by the Department of Financial Protection and
					 Innovation (Department), additional information must be submitted under
					 separate cover. Use of a new proposed FBN is not allowed until such time as
					 written approval is received from the Department approving the use of such
					 name. Approval of a new FBN may be requested by submitting under separate cover
					 a copy of the Fictitious Business Name Statement with the "filed stamp" from
					 the county clerk's office along with a written request. The applicant's name
					 must appear as a registrant on the Fictitious Business Name Statement. Refer to
					 section
					 17900
					 of the Business and Professions Code for the requirements for filing the
					 Fictitious Business Name Statement. (Fin. Code, §
												22155.)
2. Applicant's licensed place of business
				  will be located at (Fin. Code, §
											22106):
_____________________________________
(Number and
							 Street)
(City)
(County)
(State)
(Zip)
_____________________________________
(Telephone Number)
(Fax Number)
3.
				  The FULL first, middle (if no middle name, so indicate) and last name of the
				  individual in charge of this location. Each office must have a person who is in
				  charge and the same individual cannot be in charge of multiple locations.
________________________________
* (Last Name)
(First
							 Name)
(Middle Name)
(*Complete a Statement of Identity and Questionnaire (FS
					 512 SIQ). The form is located on the Department of Financial Protection and
					 Innovation's website at
www.dfpi.ca.gov
and is printed as Exhibit C in section
					 1422. If the Statement of Identity
					 and Questionnaire form has already been provided to the Department for this
					 individual, there is no need to provide another form. (Fin. Code, §
												22105.))
4. Indicate by marking the appropriate box if
				  there has been or will be ANY CHANGE in the applicant's plan of business of
				  making or brokering loans or other business as described in Financial Code
				  section
				  22154 that
				  was previously submitted to the Department. If "yes", provide explanation.
[] Yes (explain)
________________________________________________________________________________
[] No
5.
				  Provide license number and address of one other California Financing Law
				  license held by this applicant.
License Number ______________________________ Address
					 ______________________________
6. Provide the name, title, address, email
				  address, and telephone number of the person to contact regarding this
				  application. The license will also be provided to this person unless otherwise
				  instructed. The name of the person must be a responsible officer or compliance
				  person from the main office of the company. The name of the branch manager does
				  not belong here.
___________________________
							 Attention:
(Name)
(Title)
___________________________
Number and
							 Street)
(City)
(State)
(Zip
							 Code)
___________________________
(Email Address)
(Telephone Number)
REQUIRED EXHIBITS:
EXHIBIT A (Social Security Number or Federal Taxpayer
					 Identification Number):
If the applicant is an individual (sole proprietor),
					 provide the applicant's social security number, or the federal taxpayer
					 identification number if the applicant is a business entity other than a sole
					 proprietorship. Label the document as Exhibit A.
EXHIBIT B (Not Applicable)
EXHIBIT C (Statement of Identity and
					 Questionnaire):
For the individual named in Item 3, provide a Statement of
					 Identity and Questionnaire. If applicable, provide fingerprint information and
					 the cost of fingerprint processing.
In the event of the issuance of a license, applicant agrees
					 to comply with the requirements of the California Financing Law and rules
					 adopted, and orders issued, by the Commissioner of Financial Protection and
					 Innovation, and further agrees that in the event of any change of its officers,
					 directors, or any other persons named in this application, that an amendment to
					 the application containing the same information in relation to the new
					 person(s) as is required in the application shall be filed with the
					 Commissioner of Financial Protection and Innovation within thirty days from the
					 date of the change. (Cal. Code Regs., tit. 10, §
												1409.)
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.
If the proposed location in Item Number 2 is out-of-state,
					 applicant agrees to make its books and records available in this state, or pay
					 the reasonable expenses incurred during an investigation or examination outside
					 this state.
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. 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 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.
___________________________
(Applicant)
Executed at ___________________________
___________________________
(City, County, and
								State)
(Signature of
								Declarant)*
Date
								___________________________
___________________________
(Typed Name of
								Declarant)*
___________________________
(Title)*
* This Short Form Application must be signed by an officer
					 who has PREVIOUSLY completed and submitted a Statement of Identity and
					 Questionnaire. No other officer is authorized to sign documents on behalf of
					 the applicant.