Form DBO-550 Emergency Contact Person Information - California

Form DBO-550 is a California Department of Business Oversight form also known as the "Emergency Contact Person Information". The latest edition of the form was released in May 1, 2017 and is available for digital filing.

Download a PDF version of the Form DBO-550 down below or find it on California Department of Business Oversight Forms website.

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STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
EMERGENCY CONTACT PERSON INFORMATION
DBO-550 (Rev. 5-17)
This form is for Department of Business Oversight’s licensees and reporting institutions to
provide information about their designated emergency contact person:
Mr.
Ms.
Mrs.
Name (first, middle last)
Title
Institution Name
Address
City, State/Prov.,
Country, Zip or postal code
E-mail address
Telephone number
Cellular phone number
Fax number
If the person listed above is replacing a prior emergency contact person, please list the prior
contact’s data here:
Name (first, middle last)
Title
STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
EMERGENCY CONTACT PERSON INFORMATION
DBO-550 (Rev. 5-17)
This form is for Department of Business Oversight’s licensees and reporting institutions to
provide information about their designated emergency contact person:
Mr.
Ms.
Mrs.
Name (first, middle last)
Title
Institution Name
Address
City, State/Prov.,
Country, Zip or postal code
E-mail address
Telephone number
Cellular phone number
Fax number
If the person listed above is replacing a prior emergency contact person, please list the prior
contact’s data here:
Name (first, middle last)
Title
STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
EMERGENCY CONTACT PERSON INFORMATION
DBO-550 (Rev. 5-17) Page 2 of 2
DBO’s Privacy Notice on Collection
DBO Collects and Uses Personal Information: The DBO collects the information requested on
this form as authorized by Financial Code sections 453, 454, 455 and 2039(e). The DBO uses this
information to maintain a list of primary contacts for each licensee. 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 Mandatory: When providing information or documents,
please do not include unrequested personal information such as a Social Security number, driver’s
license number, or financial information.
DBO May Disclose Your Personal Information: We may share your personal information with
other state departments, the federal government or law enforcement. 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.

Download Form DBO-550 Emergency Contact Person Information - California

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