STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR LICENSE UNDER THE ESCROW LAW
DBO-EL 301 (Rev. 5-17)
DBO USE ONLY BEFORE THE DEPARTMENT OF
Fee Paid $ BUSINESS OVERSIGHT
Receipt No. OF THE STATE OF CALIFORNIA
IN THE MATTER OF THE APPLICATION
OF
FOR A LICENSE UNDER THE ESCROW
LAW
This application must be accompanied by a filing fee of $625.00 and
an
investigation fee of
$100.00. These fees are not refundable.
These
fees should be paid by check to the Department
of Business Oversight
and
mailed to the Los Angeles office at 320 West 4th Street, Los
Angeles,
CA
90013.
For the purpose of securing an Escrow Agent's license, Joint
Control
Agent's license, or
Internet Escrow Agent's license, applicant
sets
forth the following sworn statements of
fact:
1. Name of
Applicant:
2. Applicant will do business as (Check one or more
boxes):
[ ] An Escrow
Agent
[ ] A Joint Control Agent
[ ] An Internet Escrow Agent
3. Applicant's licensed place of business shall
be:
(Number and Street) (City) (County) (State)
(Zip)
4. Date of
Incorporation:
State
of
Incorporation:
THE PERSON(S) FILING THE APPLICATION IS (ARE) RESPONSIBLE FOR
ENSURING
THAT ALL REQUIRED INFORMATION AND EXHIBITS ARE FILED WITH
THE
APPLICATION. ONLY COMPLETE APPLICATIONS WHICH INCLUDE ALL
REQUIRED
INFORMATION AND EXHIBITS WILL BE ACCEPTED FOR FILING.
INCOMPLETE
APPLICATIONS WILL BE
RETURNED.
STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR LICENSE UNDER THE ESCROW LAW
DBO-EL 301 (Rev. 5-17) Page 2 of 6
5. Names of officers and
directors:
Full first and middle names MUST be given; if no middle
name,
please so
indicate. (Attach list as Exhibit if space
is
insufficient)
President:
________
Vice
President:
________
Secretary:
__________________________________________________________
Treasurer:
________
Other Officers (If
any):
_____ _______
_______________________________________________________________________________________________
Directors:
_______
6. Names of stockholders (or proposed stockholders) and
incorporators.
(Attach list as Exhibit if space is
insufficient)
7. The following officers, directors, stockholders and employees
are
to be stationed at
the licensed
location.
Full first and middle
names
must be given; if no
middle
name, please so indicate.
Position or
Title
8. Name of person proposed as manager and claiming the
qualifications
of
Financial
Code
(FC)
Section
17200.8
is:
STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR LICENSE UNDER THE ESCROW LAW
DBO-EL 301 (Rev. 5-17) Page 3 of 6
9. Name of person who will be acting as escrow holder of the corporation’s stock certificates:
__________________________________________________________________________________
10. The fiscal year end
is:
_
Note: If you do not designate a fiscal year end, the Department
of
Business Oversight will
record the corporation's fiscal year end
as
December
31.
11. Any and all attachments, exhibits, or materials, or
information
supplied at the request of
the Commissioner of Business Oversight, at
any
time, are incorporated into and made
part of this application as
if
fully set forth
therein.
(a) Exhibit ___________ _. A Statement of Identity and Questionnaire, (FS
512
SIQ) for each person
named in paragraphs 5, 6 and 8 above.
(b) Exhibit___. A Statement of Identity and Employment
Application (EL 17419) from each
person who is not required to file FS 512 SIQ in paragraph 7 above.
(c) Exhibit____. A Notice of Officers, Directors, Trustees, Employees-or Other Persons
Directly or Indirectly Compensated by Escrow Agents (EL 1726) and fingerprint cards for
each person named in paragraphs 5, 6, 7 and 8 above. The appropriate fee as described
in EL 1726 must accompany the application.
(d) Exhibit____. An affidavit for each person named in paragraphs 5, 6 and 8 above. See
attached Affidavit form.
(e) Exhibit____. A corporate resolution or a copy of the board of directors-minutes appointing
an escrow holder, and a letter of consent from the proposed escrow holder named in
paragraph 9 above.
(f) Exhibit____. An Escrow Agent Manager Questionnaire (EL 330) indicating that the
proposed manager named in paragraph 8 above has met the qualifications of FC Section
17200.8. If the proposed manager has been previously approved by the Department of
Business Oversight also submit a copy of the letter approving the manager.
(g) Exhibit____. A copy of the original Articles of Incorporation showing the date of filing with
the Secretary of State and any amendments thereto.
(h) Exhibit____. A copy of the bylaws and any amendments thereto.
(i) Exhibit____. The original surety bond or cash bond in compliance with FC Section 172.02
or 17202.1.
(j) Exhibit____. A “Customer Authorization of Disclosure of Financial Records” (LE 500.262),
completed and signed by an owner or an officer or director.
STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR LICENSE UNDER THE ESCROW LAW
DBO-EL 301 (Rev. 5-17) Page 4 of 6
(k) Exhibit____. An audited financial statement showing compliance with FC Section 17210.
(l) Exhibit____. An itemized statement on a monthly basis of the estimated receipts and
expenditures for the purposed first year of operation. The schedule must show the
estimated profit or loss for each month, as well as the accumulated net earnings or deficit
for each month, i.e., year to date. Applicant must indicate the specific basis used to
support the amount shown as estimated income.
(m)Exhibit____. If applicant is a foreign corporation, documents necessary to do business in
California pursuant to FC Section 17008.
(n) Exhibit____. A minimum fidelity bond in the amount of $125,000 is required if applicant is
not required to be a member of Escrow Agents’ Fidelity Corporation and will be engaged
in the business of receiving escrows for deposit or delivery of the types of transactions not
specified in subdivision (c) of FC Section 17312.
(o) Exhibit____. If the fidelity bond contains a deductible, the escrow agent is required to file
with this Department a surety bond (Form EL 303 A) in the amount of the deductible. The
amount of surety bond needs to be maintained in the same amount as the deductible at all
times.
In the event of the issuance of this license, applicant will abide by all rules and regulations issued by
the Commissioner of Business Oversight, and applicant hereby agrees that in the event of any
change of its officers, directors, stockholders, the person in charge of the licensed location, or the
hiring of any new employees a statement of memorandum of said change will immediately be
forwarded to the Commissioner setting forth such change made, and the effective date thereof, the
name of the person involved therein, and containing a statement of the qualifications of each
successor.
I acknowledge that this application and all exhibits thereto and any amendments made as described
above are subject to public inspection pursuant to Section 250.10, Title 10, California Code of
Regulations. A request for confidentiality of certain documents may be requested pursuant to Section
250.10. If a request for confidential treatment is granted, the person making such request will be
notified in writing.
WHEREFORE, applicant requests that a license be issued by the Commissioner authorizing applicant
to act under the Escrow Law within the State of California.
STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR LICENSE UNDER THE ESCROW LAW
DBO-EL 301 (Rev. 5-17) Page 5 of 6
I certify (or declare) under penalty of perjury that I have read the foregoing application, including all
exhibits attached, or filed therewith, and know the contents thereof, and that the statements therein
are true and correct of my own knowledge.
Executed at___________________________, California____________________, 20___.
_______________________________________________
(Signature)
_______________________________________________
(Name)
_______________________________________________
(Title)
Note: If executed outside the State of California, attach a verification executed and sworn to before a
Notary Public.
Please indicate the name, address and telephone of the person who should be contacted for
information regarding this application. The license will also be mailed to this person unless otherwise
instructed.
Name:_______________________________________________________________
Address:_____________________________________________________________
_____________________________________________________________
Telephone:___________________________________________________________
(Area Code)
STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR LICENSE UNDER THE ESCROW LAW
DBO-EL 301 (Rev. 5-17) Page 6 of 6
DBO’s Privacy Notice on Collection
DBO Collects and Uses Personal Information: The DBO collects the information requested on this
form as authorized by the California Financial Code section 17201. The DBO uses this information
for applicants who seek to become licensed as escrow agents. Use of the personal information DBO
collects is subject to limitations contained in the Information Practices Act of 1977 and other
applicable state and federal laws.
Providing Personal Information is Voluntary: You do not have to provide the personal information
requested. If you do not want to provide personal information, such as your name, home address or
home telephone number, you may remain anonymous. However, we may not be able to contact you
or help resolve your issue.
When providing information or documents, please do not include unrequested personal information
such as Social Security number, driver’s license number, or financial information.
DBO May Disclose Your Personal Information: We may share your personal information with the
Department of Justice’s Identification and Information Branch or by other federal, state or local law
enforcement agencies, or a self-regulatory organization as authorized by law. Your personal
information may also be disclosed:
In response to a Public Records Act request, as allowed by the Information Practices Act.
To another governmental agency as required by state or federal law.
In response to a court order or administrative order, a subpoena or a search warrant.
Your Access to Your Personal Information: You may review the records maintained by DBO that
contain your personal information. To request access, contact: DBO Privacy Officer, 1515 K Street,
Sacramento, CA 95814, (866) 275-2677.
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