California Code of Regulations › Title 10 - Investment › Chapter 3 - Commissioner of Financial Protection and Innovation › Subchapter 13 - Deferred Deposit Transaction Law › Article 3 - Reports to the Commissioner › Section 2030 - Annual Report

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Annual Report Form. The annual report required under Section
				  23026 of
				  the Financial Code shall be submitted on the following form number 2030:
PLEASE READ THE ATTACHED INSTRUCTIONS CAREFULLY BEFORE
					 COMPLETING THIS REPORT. All licensees must complete the report even if no
					 business was conducted.
To: COMMISSIONER OF BUSINESS OVERSIGHT, STATE OF
					 CALIFORNIA
ANNUAL REPORT FOR LICENSEES ENGAGED IN BUSINESS UNDER
					 THE CALIFORNIA DEFERRED DEPOSIT TRANSATION LAW
For the Year Ended December 31, 20__
THIS REPORT IS REQUIRED IN ACCORDANCE WITH FINANCIAL
					 CODE SECTION
					 23026
Name of Licensee (as shown on the License):
					 ____________________
Business Phone No.: ( ) ____________________ Fax No.:
					 ____________________
E-mail Address(es) (optional):
					 ______________________________
Total number of licenses held as of December 31, 20__
					 __________
Licensee's Type of Organization
[ ]
							 Corporation [ ] Partnership
[ ] Limited Liability Company
[ ] Individual
[ ] Other:___________________________
CALIFORNIA DEFERRED DEPOSIT TRANSACTION ACTIVITY
					 REPORT FOR THE YEAR ENDED 20__
The Information being requested is for the calendar year
					 ended December 31, 20__
1. The total number of deferred deposit transactions
							 made:
___________________________
2. The total dollar amount of deferred deposit
							 transactions made:
$___________________________
3. The total number of individual customers who
							 obtained deferred deposit transactions: (Only count repeat customers
							 once)
___________________________
4. The minimum dollar amount of deferred deposit
							 transactions made:
$___________________________
5. The maximum dollar amount of deferred deposit
							 transactions made:
$___________________________
6. The average dollar amount of deferred deposit
							 transactions made:
$___________________________
(Line 2 divided by line 1)
7. The average Annual Percentage Rate (APR) agreed
							 to:
___________________________
(Total annual percentage rate as stated on the
							 agreements of all transactions divided by total number of
							 transactions)
8. The average number of days of deferred deposit
							 transactions:
___________________________
9. The total number of returned checks from deferred
							 deposit transactions:
___________________________
10. The total dollar amount of returned checks from
							 deferred deposit transactions:
$___________________________
11. The total number of returned checks from
							 deferred deposit transactions
							 recovered:
___________________________
(Include partial recoveries)
12. The total dollar amount of returned checks
							 recovered:
$___________________________
(Include partial recoveries)
13. The total number of checks from deferred deposit
							 transactions charged off:
$___________________________
(Include partial balances charged off)
14. The total dollar amount of checks from deferred
							 deposit transactions charged off:
___________________________
(Include partial balances charged off)
VERIFICATION
State of___________________________
)
) SS.
County of___________________________
)
I, the undersigned state: That I am an officer or general
					 partner or the sole proprietor or have a position of similar proprietary
					 interest of (Insert name as shown on the license)
___________________________
and I have read and signed the report and the documents
					 filed herewith and know the contents thereof, I certify this annual report is
					 to the best of my knowledge true and exact.
Complete Section (A) OR Section (B) as appropriate.
(A) IF LOCATED IN CALIFORNIA OR IN A STATE
				  WHICH PERMITS A DECLARATION UNDER PENALTY OF PERJURY, COMPLETE THIS SECTION.
				  NOTARIZATION IS NOT NECESSARY.
Date __________(Month/Day), __________(Year) at
					 __________(City), __________(State)
I certify (or declare) under the penalty of perjury that
					 the foregoing is true and correct.
______________________________
(Signature of Declarant)
______________________________
(Name and Title (Please type or print))
Phone Number: ( ) ____________________ Fax Number: ( )
					 ____________________
(B) IF
				  LOCATED OUTSIDE OF CALIFORNIA IN A STATE WHICH DOES NOT PERMIT A DECLARATION
				  UNDER PENALTY OF PERJURY, COMPLETE THIS SECTION. NOTARIZATION IS REQUIRED.
Date ____________________(Month/Day), __________(Year)
					 ____________________Signature of Affiant
____________________(City)
___________________________________
______________________________________________________________
(State)
Name and Title (Please type or print)
Subscribed and sworn
							 to before me on
(Seal)
______________________,
___________________________
(Month/Date)
(Year
_______________________________________________________________
Notary Public in and for said County
								and State