Fillable NJ DEPARTMENT OF BANKING AND INSURANCE LICENSING SERVICES (State of New Jersey)

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NJ DEPARTMENT OF BANKING AND INSURANCE LICENSING SERVICES (State of New Jersey)

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The NJ DEPARTMENT OF BANKING AND INSURANCE LICENSING SERVICES (State of New Jersey) form is 3 pages long and contains:

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  • 4 check-boxes
  • 12 other fields

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File type: PDF

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NJ DEPARTMENT OF BANKING AND INSURANCE
LICENSING SERVICES BUREAU
PO BOX 473
TRENTON, NJ 08625
BRANCH OFFICE INSTRUCTIONS
1. Indicate the type of branch license being requested in the space provided.
2. Type or print clearly all answers. Do not leave any questions unanswered. If a question is not
applicable or the answer is none, please type or print N/A or NONE.
3. Insert on line #1, the complete name of the corporation, limited liability company, partnership, or sole
proprietorship exactly as it appears in your incorporation/formation papers as filed with the N J
Division of Revenue or on your trade name certificate filed with your County Clerk’s office.
4. Application must be properly signed and dated. Signatures must be witnessed by a notary public or
attorney.
5. Send a company check or money order made payable to: Treasurer, State of New Jersey. The
check must be in the amount listed in the schedule below for the license type selected on the
application. Personal checks are not accepted.
LICENSE TYPE
NON-REFUNDABLE
FEE
Motor Vehicle Installment
Seller
$300.00
Home Repair Contractor
$300.00
Home Finance Agency
$400.00
Pawnbroker
$500.00
Check Casher
$700.00
Insurance Premium Finance
Company
$500.00
Non-Profit Debt Adjuster
$300.00
NOTE: All fees submitted with an application are NON-REFUNDABLE.
Questions regarding an application may be directed to (609) 292-7272 – follow the prompts and select
option #3, then select option #2, and then select option #1 to be connected to Banking Licensing.
Send to: For Overnight delivery:
Licensing Services Bureau Licensing Services Bureau:
Dept. of Banking & Insurance Dept. of Banking & Insurance
P.O. Box 473 20 W. State St. – 8
th
Floor
Trenton, NJ 08625 Trenton, NJ 08608
GENBRINST811
Special Instructions for the HOME REPAIR CONTRACTOR BRANCH
In addition to following the general instructions, you must also submit:
PROPERTY DOCUMENTATION
Attach a copy of deed, lease or rental agreement for each location to be licensed as listed on the
application. You must also submit two (2) photographs of the office location- one exterior and
one interior. One (1) photograph must clearly show the required business sign.
RESIDENCE
If you conduct business from a residence, you must attach copies of letters you have sent to your
local post office and telephone company advising them of the use of your residence for your
business. You must also submit a copy of the deed, lease or rental agreement for the residence.
NOTE: If you employ salespersons to execute home repair contracts with homeowners on behalf
of your company, you must license each individual so employed. Officers of the corporation are
not required to be licensed as a home repair salesperson.
HRCBRSPECINST811
DEPARTMENT USE ONLY:
Ref No. Rel No. C/R No. Date Proc.
STATE OF NEW JERSEY
DEPARTMENT OF BANKING and INSURANCE
LICENSING SERVICES BUREAU
PO Box 473
Trenton, NJ 08625
BRANCH APPLICATION
INDICATE TYPE OF LICENSE:
Motor Vehicle Installment Seller
Home Repair Contractor Pawnbroker
Check Casher
T
YPE OR PRINT CLEARLY
1. Name of Applicant:_______________________________________________________________________
D
/B/A or Trade Name (if applicable)_________________________________________________________
2. Principal address as it appears on license:
_____________________________________________________
________
___________________________________________________Reference No.___________________
3. A
ddress of branch office to be licensed(include, city, state, county & zip code)________________________
_________
________________________________________________________________________________
CERTIFICATION
I, the applicant, being duly sworn according to law depose and say that the answers set forth are true to the best
of my knowledge and belief. This application is made for the purpose of inducing the issuance of a banking
license and I understand that any information withheld or which represents a material misstatement will
constitute grounds for rejection of this application by the Commissioner of Banking and Insurance.
____________________________________________
Signature of Corporate President, Partner, Sole Proprietor
____
_____________________________________________
Date
Subscribed and sworn to before me at
__________________________________________________
t
his ______________day of_____________________20_____
__________________________________________________
(Official Title)
GENBRAPP212NJ
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NJ DEPARTMENT OF BANKING AND INSURANCE LICENSING SERVICES (State of New Jersey)

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Completed 6 April 2022

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