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. 28, July 12, 2024
(a)
(1) On or after October 1, 2021, an applicant
				  shall file an application for a license under the California Financing Law
				  through NMLS in accordance with its procedures, as provided in section
				  1422.5 of these rules.
(2) On or after the date in paragraph (a)(1),
				  an applicant shall not use the form set forth in this section to initiate an
				  application for a license under the California Financing Law but may use
				  sections of the form as otherwise directed in this subchapter.
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:
1.
a.
Name of Applicant:
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.
1.
b.
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.
1.
c.
Filing of Fictitious Business Name:
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.
4.
a.
Name of Sole Proprietor Applicant:
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."
4.
b.
Person(s) Who Will Be in Charge of
				  the Place of Business:
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.
4.
c.
Agent for Service of Process (Sole Proprietor Applicants Outside of
				  California ONLY):
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.
5.
a.
Organization:
Include the full date (month, day, and year) and the state
					 where the partnership was organized.
5.
b.
General Partners:
Provide the requested information for all general partners
					 and indicate if the general partner is a managing general partner by checking
					 the box.
5.
c.
Person(s) Who Will Be in Charge of
				  the Place of Business:
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.
5.
d. and
				  5.e.
Other Persons:
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.
5.
f.
Agent for Service of Process
				  (General Partnership Applicants ONLY):
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.
6.
a.
Organization:
Include the full date (month, day, year) of organization
					 and the state where the applicant was organized.
6.
b.
Officers and Directors:
List the full name of each of the officers, directors,
					 managers, and trustees.
6.
c.
Person(s) Who Will Be in Charge of the Place of Business:
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.
6.
d. and
				  6.e.
Other Persons:
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:
10.
a.
Proposed Activities:
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.
10.
b.
Business Plan:
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:
(1) The account must be a generic address and
				  not an individual's email.
(2) The
				  account must allow the receipt of all "@govdelivery.com" emails.
(3) The security settings of the account must
				  allow for the receipt of attachments.
(4) The account must allow for the
				  distribution of emails to the appropriate individuals within the
				  applicant.
(5) The account must be
				  continuously maintained.
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:
1. Read the instructions on the bond form
				  before completing the bond.
2. The
				  bond and the cover page of the bond must be in the name of the applicant as
				  provided in Item Number 1 of this application under "Name of
				  Applicant".
3. The bond must be
				  signed by the applicant (if the applicant is a sole proprietor), or by one of
				  the individuals named in Item Number 4, 5, or 6 of the application and who is
				  authorized to sign on behalf of the applicant, in the space designated
				  "Signature of Principal".
4. The
				  signature of the applicant must be notarized.
5. The bond must contain the original
				  power-of-attorney-form issued by the surety bond company.
6. The bond must be signed by the surety bond
				  company in the space designated "Signature of Attorney-in-Fact for Surety" and
				  the signature must be notarized.
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.
CFL Application
								Checklist
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
I. General Partnership Licensee
								Information
GP ONLY X
GP ONLY X
J. Limited Partnership & LLC Licensee
								Information
X
X
LP ONLY X
LP ONLY X
K. Foreign Limited Partnership & LLC Licensee
								Information
X
LP ONLY X
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.
___________________________
___________________________
1.
a. Name
				  of Applicant:
___________________________
b. Fictitious Business Name:
___________________________
c. Fictitious Business Name filed in the
				  County of:
2. Applicant
				  is organized and will do business as (check as applicable):
[] 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):
___________________________
3. Applicant's proposed licensed place of
				  business:
___________________________
(Number and
							 Street)
(City)
(County)
(State)
(Zip)
4.
				  If the applicant is a sole proprietor, provide the following information:
a. The
FULL
first, middle (if no
				  middle name, so indicate) and last name of the sole proprietor.
___________________________
(Name)
b. The FULL first, middle (if no middle name,
				  so indicate) and last name, complete business address, telephone number, and
				  e-mail address, if any, for each person(s) who will be in charge of the place
				  of business.
___________________________
(Name)
(Telephone Number) (E-mail
							 Address)
___________________________
(Number and
							 Street)
(City)
(State)
(Zip)
c.
				  If the applicant has listed a business location outside of California in Item
				  Number 3, provide the
FULL
first, middle (if no middle name, so
				  indicate) and last name, and complete address of an agent for service of
				  process in California. If there is no authorized agent in California, so
				  indicate.
___________________________
(Name)
___________________________
(Number and
							 Street)
(City)
(State)
(Zip)
5. If the applicant is a general partnership
				  or a limited partnership, provide the following information:
a. Applicant was organized on
				  ______________________________(Date MM/DD/YYYY) in the State of
				  ______________________________.
b.
				  The
FULL
first, middle (if no middle name, so indicate) and last
				  name, and complete business address for each general partner. Indicate if a
				  general partner is a managing general partner by checking the corresponding
				  box.
___________________________
Check here if a Managing
							 Partner []
(Name)
____________________________________________________
(Number and
							 Street)
(City)
(State)
(Zip)
c.
				  The
FULL
first, middle (if no middle name, so indicate) and last
				  name, complete business address, telephone number, and e-mail address, if any,
				  for each person(s) who will be in charge of the place of business.
________________________________________________________
(Name)
(Telephone Number) (E-mail Address)
_________________________________________________________
(Number and
							 Street)
(City)
(State)
(Zip)
d.
				  The
FULL
first, middle (if no middle name, so indicate) and last
				  name for any other person responsible for the conduct of applicant's lending
				  activity in this state.
___________________________
___________________________
(Name)
(Name)
e.
				  The
FULL
first, middle (if no middle name, so indicate) and last
				  name for any person (individual, other than those persons listed above, or
				  entity) that owns or controls, directly or indirectly, 10 percent or more of
				  the outstanding interests of the applicant.
___________________________
___________________________
(Name)
(Name)
f.
				  If the applicant is a general partnership, provide the FULL first, middle (if
				  no middle name, so indicate) and last name, and complete address of an agent
				  for service of process in California. If there is no authorized agent in
				  California, so indicate.
___________________________
(Name)
___________________________
(Number and
							 Street)
(City)
(State)
(Zip)
6. If the applicant is a corporation, limited
				  liability company, joint venture, association, joint stock company, trust,
				  unincorporated organization, government, or political subdivision of a
				  government, provide the following information:
a. Applicant was organized on
				  ______________________________(Date MM/DD/YYYY) in the State of
				  ______________________________.
b.
				  The
FULL
first, middle (if no middle name, so indicate) and last
				  name, be given for each person named below. Complete all fields. If any title
				  is not applicable, so indicate.
President/Chief Executive
								Officer
:
Executive Vice
								President/Vice President:
___________________________
________________________________________
(Name)
(Name)
Secretary
:
Treasurer/Chief Financial
								Officer:
___________________________
________________________________________
(Name)
(Name)
Directors
:
___________________________
________________________________________
(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]:
___________________________
___________________________
(Name)
(Name)
Trustee(s):
___________________________
___________________________
(Name)
(Name)
c.
				  The
FULL
first, middle (if no middle name, so indicate) and last
				  name, complete business address, telephone number, and e-mail address, if any,
				  for each person(s) who will be in charge of the place of business.
___________________________________________
(Name)
(Telephone
							 Number)
(E-mail Address)
___________________________________________
(Number and
							 Street)
(City)
(State)
(Zip)
d.
				  The
FULL
first, middle (if no middle name, so indicate) and last
				  name for any other person responsible for the conduct of applicant's lending
				  activity in this state. Indicate if no other person is responsible.
___________________________
___________________________
(Name)
(Name)
e.
				  The
FULL
first, middle (if no middle name, so indicate) and last
				  name for any person (individual, other than those persons listed above, or
				  entity) that owns or controls, directly or indirectly, 10 percent or more of
				  the outstanding equity securities of the applicant.
___________________________
___________________________
(Name)
(Name)
7.
a. Has
				  the applicant, any individual(s) or entity(s) required to be disclosed in
				  response to Items 4 through 6 above, or any individual(s) or entity(s)
				  disclosed in Exhibit M, been convicted of or pleaded nolo contendere to a
				  crime, or committed an act involving dishonesty, fraud, or deceit within the
				  last 10 years?
[] 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:
					 ___________________________________
7.
b. Has
				  the applicant, any individual(s) or entity(s) required to be disclosed in
				  response to Items 4 through 6 above, or any individual(s) or entity(s)
				  disclosed in Exhibit M, at any time violated the California Financing Law or
				  regulations, or any similar regulatory scheme of California or a foreign
				  jurisdiction?
[] 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:
					 ___________________________________
8. Does the applicant conduct or intend to
				  conduct any other business at the applicant's proposed licensed place of
				  business (Item Number 3 above)?
[] 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.
___________________________
___________________________
___________________________
___________________________
___________________________
9. Provide the name, address, and telephone
				  number of the bonding agent to whom the Department can direct questions
				  regarding the surety bond required in Exhibit B below.
__________________________________________________________
(Name of Bonding Agent)
(Telephone Number)
__________________________________________________________
(Number and Street)
(City)
(State)
(Zip)
10.
				  Complete the following as it applies to your proposed operations:
a. In the table below, mark the type of
				  collateral and enter the corresponding minimum loan amount for commercial and
				  consumer loans applicable to your proposed method of operation.
COMMERCIAL LOANS
CONSUMER LOANS
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.
b. Provide the applicant's business plan,
				  including 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.
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
11. Has the applicant's offer and sale of
				  securities been qualified in California?
[] 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.
12. Provide the applicant's designated email
				  account for communications from the Department of Financial Protection and
				  Innovation:
13. Has the applicant
				  registered online and designated a dedicated email address through the DFPI
				  Self Service Portal at
https://docqnet.dfpi.ca.gov/
? [] Yes
				  [] No
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:
1. That the applicant has
				  obtained and read copies of the California Financing Law (Division 9 of the
				  California Financial Code) and the California Financing Law Rules (Chapter 3,
				  Title 10, California Code of Regulations) and is familiar with their
				  content.
2. That the applicant
				  agrees to comply with the requirements of the California Financing Law, the
				  rules adopted, and the orders issued by the Commissioner of Financial
				  Protection and Innovation.
3. That
				  in the event of any change of its officers, directors, or any other persons
				  named in this application, the applicant will file an amendment to the
				  application containing the same information in relation to the new person(s) as
				  is required in the application, within thirty days from the date of the change,
				  with the Commissioner of Financial Protection and Innovation.
4. That the applicant will file with the
				  Commissioner of Financial Protection and Innovation an amendment to this
				  application prior to any material change in the information contained in the
				  application for licensure, including, without limitation, Items 7, 8, and 10,
				  and Exhibits C and M.
5. That the
				  applicant agrees to report any change of business location at least 10 days
				  prior to the change.
6. That the
				  applicant for a broker's license agrees that a license issued pursuant to the
				  California Financing Law does not provide the authority to broker loans to
				  lenders that are not licensed as finance lenders as defined in Financial Code
				  section
				  22009; that
				  the applicant will maintain any license necessary to broker loans to a lender
				  not licensed as a finance lender; and that a finance lender may not pay
				  compensation for brokerage services (i.e., brokerage commission, finder's fee,
				  referral fees, etc.) to anyone not licensed as a broker under this division,
				  except for those exempt persons as provided in section
				  1451 of the Department's
				  regulations (Cal. Code Regs., tit. 10, §
												1451).
7. For purposes of Financial Code sections
				  22340 and
				  22600, when
				  selling loans secured by real property to institutional investors, the
				  applicant agrees that the source of funds will be exclusive of any funding
				  advances from an institutional investor committed to purchasing the note. The
				  practice commonly known as "table funding" is not permitted under the
				  California Financing Law.
8. That
				  the applicant agrees that 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.
9. That
				  the applicant agrees that 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).
10. That the applicant agrees to obtain a new
				  license issued pursuant to the California Financing Law for each additional
				  location.
11. That the applicant
				  agrees to comply with limitations on rates and charges for loans under the
				  California Financing Law.
12. That
				  the applicant agrees to obtain the Commissioner of Financial Protection and
				  Innovation's approval prior to engaging in other business at a licensed
				  location, unless that other business is providing products or services of an
				  affiliated supervised financial institution.
13. That the applicant agrees that real
				  estate may not be taken as security for a consumer loan of less than
				  $5,000.
14. That the applicant
				  agrees that commercial loans of less than $5,000 are treated as consumer loans
				  under the law.
15. For high
				  interest rate loans secured by real estate, that the applicant agrees to comply
				  with the additional disclosure and consumer protection requirements of the
				  Covered Loan Law and Regulation Z regarding high-cost mortgages and
				  higher-priced mortgage loans (Fin. Code, §
												4970 et seq.; Fin. Code, §
												4995;
				  12 C.F.R. §
													226 et seq.;
				  12 C.F.R. §
													1026 et seq.).
16. That the applicant agrees to not share
				  borrower information with third parties without obtaining the express written
				  consent of the borrower, as required by the California Financial Information
				  Privacy Act (Fin. Code, §
												4050 et seq.).
17. That the applicant agrees to not charge
				  interest on a consumer loan secured by real estate for more than one day prior
				  to the date the loan proceeds are disbursed from escrow in accordance with
				  Civil Code section
				  2948.5.
18. That the applicant will maintain adequate
				  staff to meet the requirements of the California Financing Law, as prescribed
				  by rule or order of the Commissioner of Financial Protection and
				  Innovation.
19. That the applicant
				  agrees to maintain accounting records that meet generally accepted accounting
				  principles and demonstrate a net worth of at least $25,000 at all
				  times.
20. That the applicant will
				  file with the Commissioner of Financial Protection and Innovation any report
				  required by the Commissioner.
21.
				  That the applicant agrees to maintain books and records sufficient to document
				  compliance with the California Financing Law.
22. That the applicant will keep and maintain
				  for 36 months from the date of final entry on any loan the business records and
				  other information required by law or rules of the Commissioner of Financial
				  Protection and Innovation.
23. That
				  the applicant will maintain a register of all loans made or brokered under this
				  license that will be updated at least monthly, and that the information
				  maintained in the register will include, at a minimum, the name and address of
				  the borrower, account number, amount of loan, date of loan, terms, total of
				  payments and the annual percentage rate, and that the register will also show
				  the account number, name of borrower and payoff date of all loans paid in
				  full.
24. That the applicant will
				  submit to periodic examinations by the Commissioner of Financial Protection and
				  Innovation as required by the California Financing Law.
25. That the applicant agrees to pay for the
				  costs of each examination.
26. That
				  the applicant, if located outside of the State of California, agrees to make
				  available to the Commissioner of Financial Protection and Innovation or the
				  Commissioner's representatives, at a location in this state designated by the
				  Commissioner of Financial Protection and Innovation, or the Commissioner's
				  representatives, the books, accounts, papers, records and files within 10
				  calendar days of any request from the Commissioner; or to pay the reasonable
				  expenses for travel, meals, and lodging of the Commissioner of Financial
				  Protection and Innovation or the Commissioner's representatives incurred during
				  any investigation or examination made at the licensee's location outside this
				  state.
27. That the applicant
				  agrees to pay an annual assessment each year of a minimum of $250 per
				  location.
28. That the applicant
				  agrees to file an annual report by March 15 of each year.
29. That the applicant agrees to maintain a
				  surety bond of $25,000 at all times.
30. That the applicant hereby attests that
				  the applicant (including officers, directors, general partners, persons
				  responsible for the applicant's lending activities in California and persons
				  owning or controlling, directly or indirectly, 10 percent or more of the
				  outstanding interests or outstanding equity securities of the applicant) has
				  not engaged in conduct that would be cause for denial of a license. (Only one
				  declaration required for each applicant.)
31. That, if applicable, the applicant will
				  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.
32. That the applicant will comply with the
				  examination requirements concerning advertising pursuant to California Code of
				  Regulations, title 10, section
				  1550.
33. By signing the application, the applicant
				  hereby irrevocably appoints the Commissioner of Financial Protection and
				  Innovation of the State of California, or the Commissioner's successor in
				  office, to be the undersigned's attorney to receive service of any lawful
				  process in any noncriminal suit, action or proceeding against the undersigned,
				  or the undersigned's successor, executor, or administrator which arises under
				  the California Financing Law or any rule or order thereunder after this consent
				  has been filed, with the same force and validity as if served personally on the
				  undersigned. For the purpose of compliance with the California Financing Law of
				  the State of California, notice of the service and a copy of process must be
				  sent by registered or certified mail to the undersigned at the following
				  address:
__________________________________
(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:
1. The signature of the attorney-in-fact for
				  the surety company.
2. A notarized
				  signature of the attorney-in-fact.
3. A power of attorney from the surety
				  company.
4. Legal name of the
				  licensee. Business name(s), if applicable, may also be included.
5. The signature of the licensee.
6. A notarized signature of the
				  licensee.
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:
1. That any person who sustains an injury
				  covered by this bond may, in addition to any other remedy that he or she may
				  have, bring an action in his or her own name upon this bond for the recovery of
				  any damages sustained by him or her.
2. That the total aggregate liability of the
				  Surety or sureties herein shall be limited to the payment of
				  _________________________ Dollars ($ ____________________) (insert amount of
				  the bond).
3. This bond may be
				  canceled by the Surety in accordance with the provisions of sections
				  996.320
				  and
				  996.330
				  of the Code of Civil Procedure of the State of California.
4. That, in the event either the Principal
				  and/or the Surety under this bond are served with notice of any action
				  commenced against the Principal or the Surety under the bond, the Principal and
				  Surety as each is served with notice of action shall respectively and, within
				  10 days, give written notice of the filing of such action to the Commissioner
				  of Financial Protection and Innovation of the State of California, at the Los
				  Angeles office of the Department of Financial Protection and
				  Innovation.
5. That, in the event
				  the Surety under this bond makes full or partial payment on this bond the
				  Surety shall immediately give written notice of such full or partial payment to
				  the Commissioner of Financial Protection and Innovation of the State of
				  California, at the Los Angeles office of the Department of Financial Protection
				  and Innovation.
6. That the
				  effective date of this bond shall be ______________________________.
___________________________________
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 ___________________________
Email
Hours of
							 Employment
Address ___________________________
(e.g., 8:00 a.m. to 5:00 p.m.) ___________________________
1.
				  Residence addresses for the last 10 years:
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): ____________
2.
				  Employment for the last 10 years:
From
To
Employer Name and
							 Address
Occuption and Duties
Present
Attach separate schedule if space is not
					 adequate.
3.
a.
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.
b. Are you
				  currently, or have you been within the last ten years, under federal, state or
				  local investigation for possible violation of any law, ordinance, or licensing
				  or regulatory scheme?
[] Yes
[] No
If the answer is "Yes", give details:
___________________________
___________________________
4.
a. Are
				  you currently licensed to engage in financial business in this state or any
				  other state?
[] 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):
							 ___________________________
b.
				  Have you ever been refused a license to engage in any business in this state or
				  any other state, or has any such license ever been suspended, revoked, or
				  surrendered subject to a settlement, or any other similar action?
[] Yes
[] No
If the answer is "Yes", give details:
___________________________
___________________________
Attach a copy of any settlement.
5. Have you ever been convicted of or pleaded
				  nolo contendere to a misdemeanor or felony other than minor traffic citations
				  that do not constitute a misdemeanor or felony offense?
"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.
6. Have you ever
				  been a defendant in a civil court action other than divorce, condemnation or
				  personal injury?
[] 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.
7. Have you ever
				  been a subject of a bankruptcy or a petition in bankruptcy?
[] Yes
[] No
If the answer is "Yes", give date, title of case, location
					 of bankruptcy filing:
___________________________
___________________________
___________________________
8. Have you ever been refused a bond, or have
				  you ever had a bond revoked or canceled?
[] Yes
[] No
If the answer is "Yes", give details:
___________________________
___________________________
9. Have you ever changed your name, including
				  subsequent to marriage, or been known by any name other than that herein
				  listed?
[] 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
___________________________
___________________________
___________________________
___________________________
10.
				  Have you ever done business under a fictitious firm name either as an
				  individual or in any form of business, e.g., partnership limited liability
				  company, corporation or other?
[] 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.
11. In what
				  capacity will you be employed? ______________________________ (e. g., Clerk,
				  Escrow Officer, Manager, Officer, Director, etc
.
)
12. Do you expect to be a party to, or broker
				  or salesman in connection with escrows conducted by the escrow company which is
				  employing you?
[] 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