§ 1423. Short Form Application for Licensees Seeking Additional Location License; Form.

(a) The application for a licensee seeking an additional location license pursuant to Financial Code Section 22102(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 Business Oversight on the following form:

STATE OF CALIFORNIA

DEPARTMENT OF BUSINESS OVERSIGHT

INSTRUCTIONS FOR COMPLETING THE SHORT FORM APPLICATION FOR A LICENSE UNDER THE CALIFORNIA FINANCE LENDERS LAW (CFLL)

ASSISTANCE WITH THE APPLICATION

Refer to these instructions while completing the CFLL short form application. If you have questions about the application that are not answered by these instructions, call the Department of Business Oversight's toll-free telephone number at 1-[phone]. 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 CFLL licensee seeking to engage in business at an additional location must submit this application to the Commissioner of Business Oversight 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 The application fee and investigation fee are not refundable if the application is denied or withdrawn.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 Business Oversight 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 Business Oversight, located at 320 West 4th Street, Suite 750, Los Angeles, California 90013.

THE CFLL 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 CFLL 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 Business Oversight has already approved the use of that name. If the fictitious business name has not been approved by the Department of Business Oversight, approval of a new fictitious business name may be requested from the Department of Business Oversight 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 CFLL Licensing Specialist, Department of Business Oversight, 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 CFLL 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 Business Oversight 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.

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 Business Oversight's website at www.dbo.ca.gov. Adobe Reader 7.x is required to download the form correctly. 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 http://caag.state.ca.us/fingerprints/publications/contact.htm has current information concerning the Department of Justice's fees and the location of live scan terminals. You may also call the Department of Business Oversight at 1-[phone] 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 CFLL application and the Statement of Identity and Questionnaire to the Department of Business Oversight. Make the check for the fingerprint processing fees payable to the Department of Business Oversight.

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 Business Oversight on fingerprint cards. Call the Department of Business Oversight at 1-[phone] to obtain fingerprint cards. The Department of Business Oversight will mail the fingerprint cards to you. In addition, you must also complete a “Request for Exemption from Mandatory Electronic Fingerprint Submission Requirement” form, available from the Attorney General's website at http://caag.state.ca.us/fingerprints/pdf/bcii9004.pdf. The fee to process the fingerprint card is $86 per individual, which includes the Department of Business Oversight 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 Business Oversight. Submit the fingerprint cards, “Request for Exemption from Mandatory Electronic Fingerprint Submission Requirement” form, the fees, and the Statement of Identity and Questionnaire with the CFLL application to the Department of Business Oversight.

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 Business Oversight. 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 CFLL 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 Business Oversight is required to collect from all applicants social security numbers 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 Business Oversight.

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 Business Oversight Use Only)

DEPARTMENT OF BUSINESS OVERSIGHT

Fee Paid $ _______________

File No. _________________

Receipt No. ______________

STATE OF CALIFORNIA

DEPARTMENT OF BUSINESS OVERSIGHT

“SHORT FORM APPLICATION” FOR A LICENSE UNDER THE CALIFORNIA FINANCE LENDERS LAW FOR A LICENSEE CURRENTLY HOLDING ONE OR MORE LICENSES

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*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.

1423 - CFLL Short Form Instructions

HISTORY

1. New section filed 3-18-2002 as an emergency; operative 3-18-2002 (Register 2002, No. 12). A Certificate of Compliance must be transmitted to OAL by 7-16-2002 or emergency language will be repealed by operation of law on the following day.

2. New section refiled 7-10-2002 as an emergency; operative 7-15-2002 (Register 2002, No. 28). A Certificate of Compliance must be transmitted to OAL by 11-12-2002 or emergency language will be repealed by operation of law on the following day.

3. Certificate of Compliance as to 7-10-2002 order transmitted to OAL 10-30-2002 and filed 12-16-2002 (Register 2002, No. 51).

4. Amendment of section and new Note filed 11-7-2007; operative 12-7-2007 (Register 2007, No. 45).

5. Amendment of subsection (b) and Note filed 1-7-2014; operative 1-7-2014 pursuant to Government Code section 11343.4(b)(3) (Register 2014, No. 2).

Note

Note: Authority cited: Section 22150, Financial Code. Reference: Sections 31 and 494.5, Business and Professions Code; and Sections 22101, 22102 and 22106, Financial Code.