California Code of Regulations › Title 10 - Investment › Chapter 3 - Commissioner of Financial Protection and Innovation › Subchapter 2 - Corporate Securities › Article 2 - Exemptions from Qualification › Section 260.100.1 - Form of Request for Designation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Any organization which desires to be designated as one
					 entitled to the exemption for the offer and sale of life income contracts
					 pursuant to Subdivision (k) of Section
					 25100, and which is not within the
					 class designated in Section
					 260.100 of these rules, may apply
					 to the Commissioner for such a designation by order, on the following
					 form:
File
							 No._______________________________________(Insert file number of previous
							 filings before the Department, if any.)
Fee: $50
Date of Request________________________________
DEPARTMENT OF BUSINESS OVERSIGHT STATE OF CALIFORNIA
Request for designation as an exempt organization pursuant
					 to Subdivision (k) of Section
					 25100 of the Corporate Securities
					 Law of 1968.
1.
				  ___________________________
(Name of Applicant)
2. ___________________________
(Principal business address of applicant)
3. ___________________________
(State whether applicant is a corporation, trust or other
					 entity)
4. Is applicant
				  organized exclusively for educational, benevolent, fraternal, religious,
				  charitable, social, or reformatory purposes and not for pecuniary
				  profit?
5.
				  ___________________________
(Name and address of person to whom correspondence
					 regarding this request for designation should be addressed.)
6. Describe briefly the type of activities
				  engaged in by the applicant.
7.
				  There are attached hereto as exhibits, if applicable, the following which are
				  hereby incorporated by reference:
A. Financial
				  statements, including a balance sheet of recent date and a profit and loss
				  statement for each of the three fiscal years preceding the date of the balance
				  sheet. The balance sheet and profit and loss statements should reflect all
				  assets acquired from donors of property in consideration of the payment to the
				  donor or other persons of income or specified periodic payments.
B. A list containing the complete names and
				  other business affiliations of the directors, officers, trustees and/or other
				  persons who will be charged with the activities and operation of the
				  applicant.
C. A statement setting
				  forth the scope and nature of any investment advisory services that the
				  applicant has utilized or proposes to utilize, or (if no such services are
				  utilized) the investment experience of the persons to manage the investment
				  portfolio.
D. An opinion of counsel
				  with respect to the tax consequences to the prospective donors of property. The
				  applicant has duly caused this application to be signed on its behalf by the
				  undersigned, thereunto duly authorized.
_________________________
(Applicant)
By _______________________
(Title)
I certify (or declare) under penalty of perjury under the
					 laws of the State of California that I have read this application and the
					 exhibits thereto and know the contents thereof, and that the statements therein
					 are true and correct.
Executed at _______________(Place), on __________(Date ),
					 20___.
_________________________
(Signature)