Fillable NCCOB - Form RM56 Authorization to Make Reverse Mortgage Loans

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NCCOB - Form RM56 Authorization to Make Reverse Mortgage Loans

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Form - RM56 (Rev. 01/27/2015)
1
NC Commissioner of Banks
Location: 316 W. Edenton Street, Raleigh, NC 27603
Mail Address: 4309 Mail Service Center, Raleigh, NC 27699-4309
Telephone: 919/733-3016 Fax: 919/733-2978 Internet: www.nccob.gov
AUTHORIZATION TO MAKE REVERSE MORTGAGE LOANS
General Information
Unless otherwise exempt by statute, G.S. 53-258(a) requires any person, firm, or corporation
engaging in the business of making reverse mortgage loans to first be approved as an authorized
lender by the Commissioner of Banks.
Filing Instructions
The attached form (RM56) should be used to apply for authorization to make reverse mortgage
loans. Please review this information carefully and give full and complete responses to each
question. If a particular item does not apply, please enter "None" or "N/A." Incomplete responses
or failure to submit the required fees, schedules, or supporting documents will delay the
processing of your application. Form RM56 may be completed online. Please submit the
following:
A complete "application for authorization to make reverse mortgage loans" (RM56),
including Schedules A through E. Handwritten forms will not be accepted.
$500 non-refundable application fee made payable to Department of Commerce / Banking Commission.
Copy of Articles of Incorporation or Certificate of Authority (corporations only).
Incorporation documents and information may be obtained by calling the Office of Secretary
of State at (919)733-4201.
Certificate of Existence issued within 90 days of application (corporations only).
Copy of Assumed Name Certificate, if applicable.
A detailed business resume for each executive officer, partner, or director of the applicant.
Business Plan for reverse mortgage lending.
Surety Bond in amount of $100,000.
Amendments to Application
Authorized lenders must maintain a complete and current application on file with the
Commissioner of Banks. If any information contained in the application changes, you must file a
correcting amendment within 30 days. Changes to an application should be reported as follows:
Complete in full the application page to be amended and circle the number of the item being
changed. All information may be completed online. Handwritten forms will not be
accepted.
Form - RM56 (Rev. 01/27/2015)
2
Use only the "application for authorization to make reverse mortgage loans" (Form RM56)
and its schedules or a copy. Please retain a copy of the application form for filing future
amendments.
Contact Employee
The individual listed on the application form as "contact employee" must be authorized to
receive all compliance information, communications, and mailings and be responsible for
disseminating such information within the applicant's organization.
Mailing Instructions
Please mail the completed application form and fee made payable to the
Department of Commerce / Banking Commission to:
Office of the Commissioner of Banks
4309 Mail Service Center
Raleigh, North Carolina 27699-4309
Questions about application:
Contact Vivian Laney-Dobbin, NC Mortgage Licensing staff, by phone at (919) 733-3252 or
send your questions via email to vdobbin@nccob.gov for additional assistance.
Form - RM56 (Rev. 01/27/2015)
3
NC Commissioner of Banks
Location: 316 W. Edenton Street, Raleigh, NC 27603
Mail Address: 4309 Mail Service Center, Raleigh, NC 27699-4309
Telephone: 919/733-3016 Fax: 919/733-6918 Internet: www.nccob.gov
APPLICATION FOR AUTHORIZATION TO MAKE
REVERSE MORTGAGE LOANS
Date:
1. Name of applicant:
(Full legal name)
2. Are you operating under an assumed name? ☐ Yes ☐ No
If so, list name here:
(Attach copy of assumed name certificate)
3. License/NMLS ID No.: (Issued under the NC SAFE Act)
4. Organization type:
☐ Individual ☐ Partnership ☐ Corporation ☐ Association
5. State of incorporation: Date of incorporation:
Date qualified in North Carolina, if foreign corporation:
6. Applicant's headquarters address:
City:  State:  Zip Code:
7. Mailing address, if different from above:
8. Address where books and records are kept:
City: State:  Zip Code:
9. Business phone number:  Fax number:
10. Contact employee:
City:  State:  Zip Code:
Business phone number:  E-Mail:
11. Contact employee for the NC Commissioner of Banks public website if different
from No. 10.
Employee name:  Title:
Business phone number:  E-Mail:
Authorization No:
(Office Use Only) __________________________
Form - RM56 (Rev. 01/27/2015)
4
12. Provide a detailed description of the applicant's experience in mortgage lending for the
preceding five years. (Please use Schedule A)
13. Name of state(s) where the applicant and/or its affiliates are licensed or registered to make
reverse mortgage loans, consumer loans, mortgage loans, or similar loans.
Licensing Agency State Date Licensed Address/Phone
Form - RM56 (Rev. 01/27/2015)
5
14. If an individual, partnership, or association, please list all persons who hold an interest. If a
corporation, list by group all principal officers, directors, and all shareholders (including
corporations) owning five percent or more of corporate stock. If more space is needed, please
use Schedule A.
Name and Business Residence Percentage
Title Address Address Ownership
15. If 5% or more of the applicant's stock is owned by another corporation, and that corporation
is affiliated with other corporations, list the names and addresses of the other corporations on
Schedule A and the percentage of stock-ownership held by each corporation in the other.
☐ This situation exists. ☐ This situation does not exist.
16. Does/will the applicant engage in any non-related mortgage banking activities at the
location(s) to be approved in North Carolina. ☐ Yes ☐ No
If yes, please provide details on Schedule A.
17. If the applicant is an approved FHA/VA lender or servicer, please provide the approval date
and lender identification number.
18. List three references, including one bank reference, not related to or connected with the
applicant. If a company name is used as a reference, please list the name of a contact person.
Reference 1 Reference 2 Reference 3
Name:
Company:
Mailing
Address:
Phone:
E-Mail:
Form - RM56 (Rev. 01/27/2015)
6
19. Please read the following questions carefully. Provide details for affirmative responses on
Schedule A. Please list date(s), court name, case number, and judgment amount for each
action taken.
(a) Have any Civil Judgments been entered against the applicant within the last ten years?
☐ Yes ☐ No
(b) Have any members, directors, or principal officers of the applicant been suspended,
reprimanded, or disbarred by the FHA, VA, Federal National Mortgage Association,
Federal Home Loan Mortgage Corporation, or any other Federal or State agency or
corporation? ☐ Yes ☐ No
(c) Has the applicant or any member, director, or principal officer of the applicant been
indicted for or convicted of any felony? ☐ Yes ☐ No
(d) Has the applicant or any member, director, or principal officer of the applicant been
convicted of a misdemeanor involving theft, embezzlement, forgery, obtaining money
under false pretense, conspiracy to defraud, or like offense? ☐ Yes ☐ No
(e) Has the applicant filed any petition of bankruptcy, whether voluntary or involuntary,
within the preceding seven years? ☐ Yes ☐ No
20. North Carolina Registered Agent for Service of Process: (corporations only)
(a) Name:
(b) Business address:
City:  State:  Zip Code:
(c) Business phone number:
The applicant authorizes the Commissioner of Banks to conduct a background check to determine
the financial responsibility, experience, character, and general fitness of the applicant, its directors
and officers to engage in business as a Reverse Mortgage Lender.
Name of Applicant
_________________________________________
Signature / Title Date
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signature
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Form - RM56 (Rev. 01/27/2015)
7
A F F I D A V I T
STATE OF
COUNTY OF
being duly sworn, deposes and says that (s)he
signed the foregoing application and all attachments required herein, as 
(Title) of the above named applicant and that: (1) (s)he has full authority
to sign the application in said capacity; (2) (s)he has read the application and the information
contained therein is true; (3) the applicant is financially solvent; and (4) applicant, or in the case
of a corporation, partnership, association, or other form of business organization, each member,
director, and principal officer thereof, possesses the necessary educational background and
general character and fitness to conduct the business of a Reverse Mortgage Lender properly,
honestly, and fairly; and (5) said applicant has read and will comply with Article 21 of Chapter
53 of the North Carolina General Statutes in its entirety.
Full Corporate Name
By: _____________________________
Title:
ATTEST:
By: _____________________________
Title:
(CORPORATE SEAL)
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signature
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signature
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Form - RM56 (Rev. 01/27/2015)
8
STATE OF
COUNTY OF
This is to certify that on this day of , 20 ,
[Name] personally came before me and acknowledged
that (s)he is [Title] of [Corp.
Name], a corporation, and that by authority duly given and as the act of the corporation, the
foregoing instrument was signed in its name by [Attesting
Officer], sealed with its corporate seal, and attested by him or her as its
[Title].
Witness my hand and official seal, this day of , 20 .
______________________________
Notary Public
My Commission expires:
(SEAL)
Form - RM56 (Rev. 01/27/2015)
9
SCHEDULE A CONTINUATION SHEET
Applicant Name:
Date:
Instructions: This schedule may be used as a continuation sheet or to report details of
affirmative responses to questions on the application form. (Attach additional sheets as needed.)
Item No. Response
Form - RM56 (Rev. 01/27/2015)
10
SCHEDULE B BRANCH OFFICE LOCATIONS
Applicant Name:
Date:
Instructions: This schedule may be used to report all branches in which the applicant proposes
to originate or offer reverse mortgage loans that will be secured by real estate located in North
Carolina. Future filings should include only those branches to be added, deleted or otherwise
amended. When reporting a change of address, please list the old address followed immediately
by the new address. Use the Code Column as follows:
To request registration of a new branch office, enter "A."
To report a branch office closing, enter "B."
To report a change of address, enter "C."
To report a change of Branch Manager, enter "D."
Branch Office Branch Office Tel. No. Code
Address Manager
Form - RM56 (Rev. 01/27/2015)
11
SCHEDULE C EXECUTIVE OFFICES / PARTNERS / DIRECTORS
Applicant Name:
Date:
Instructions: This schedule may be used to report each executive officer, partner, or director if
the applicant is organized as a partnership, corporation, association, or other form of business
organization. Amendments should include only those individuals to be added or deleted. Use the
Code Column as follows:
To report an addition, enter "A."
To report a deletion, enter "B."
Name / Title Business Residence Code
Address Address
Form - RM56 (Rev. 01/27/2015)
12
SCHEDULE D SUBSIDIARIES AND AFFILIATES
Applicant Name:
Date:
Instructions: This schedule may be used to report each corporate subsidiary and/or affiliate. If
the applicant is a subsidiary or affiliate of another corporation, the parent company must be
listed. Amendments should include only those entities to be added or deleted. Use the Code
Column as follows:
To report an addition, enter "A."
To report a deletion, enter "B."
Company Name Business Address Code
Form - RM56 (Rev. 01/27/2015)
13
SCHEDULE E DISCLOSURE OF LOAN TERMS
Instructions: This schedule may be used to provide information and facts regarding the terms
and conditions of reverse mortgage loans made to borrowers. G.S. 53-264 requires all authorized
lenders to provide this information to the Commissioner of Banks for dissemination to all
counselors providing services to prospective reverse mortgage borrowers.
(1) The borrower's rights, obligations, and remedies with respect to the borrower's temporary
absence from the home, late payments by the lender, and payment default by the lender.
(2) Conditions or events that require the borrower to repay the loan obligation.
(3) The right of the borrower to mortgage less than the full value of the home, if permitted by the
reverse mortgage loan contract.
Form - RM56 (Rev. 01/27/2015)
14
SCHEDULE E DISCLOSURE OF LOAN TERMS
(4) The projected total annual percentage rate applicable under various loan terms, appreciation
rates, and interest rates applicable at sample ages of borrowers.
(5) Standard closing costs.
(6) All service fees to be charged during the term of the loan.
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NCCOB - Form RM56 Authorization to Make Reverse Mortgage Loans

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Completed 23 May 2020

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