Form DBO-280.200 "Application for Requesting Approval to Surrender Capital Access Company Law License" - California

What Is Form DBO-280.200?

This is a legal form that was released by the California Department of Financial Protection and Innovation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2017;
  • The latest edition provided by the California Department of Financial Protection and Innovation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DBO-280.200 by clicking the link below or browse more documents and templates provided by the California Department of Financial Protection and Innovation.

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Download Form DBO-280.200 "Application for Requesting Approval to Surrender Capital Access Company Law License" - California

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STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR REQUESTING APPROVAL TO SURRENDER CAPITAL
ACCESS COMPANY LAW LICENSE
DBO–280.200 (Rev. 10-17)
File No. ____________________________
Date of Application ___________________
COMMISSIONER OF BUSINESS OVERSIGHT
PURSUANT TO SECTION 28650 OF THE CORPORATIONS CODE
The Application for Requesting Approval to Surrender a Capital Access Company Law License
MUST BE TYPEWRITTEN and may only be filed in the Sacramento Office of the Department of
Business Oversight.
1.
Name of Applicant: ______________________________________________________
2.
Name under which business is conducted, if different from above:
______________________________________________________________________
3.
Address of actual location of principal place of business:
______________________________________________________________________
No. and Street
City
State
ZIP Code
4.
State the reason for surrendering the license:
______________________________________________________________________
5.
Does the applicant owe any money or securities to any investor?
Yes
No
If answer is “yes”, furnish all of the following information:
a.
Amount of money owed:
$_________________________________________
b.
Arrangements made for the payment of the money owed:
______________________________________________________________________
c.
Market value of securities (if applicable): ________________________________
d.
Arrangements made for the return or delivery of securities:
______________________________________________________________________
6.
Has applicant assigned any of its contracts to another person?
Yes
No
If answer is “yes” furnish all of the following information:
a.
Name and business address of the person(s) to whom the contracts were assigned:
______________________________________________________________________
b.
Name of contact person: ____________________________________________
c.
What alternative was provided with respect to those investors who did not
consent to the assignment of their contracts?
________________________________________________________________
STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR REQUESTING APPROVAL TO SURRENDER CAPITAL
ACCESS COMPANY LAW LICENSE
DBO–280.200 (Rev. 10-17)
File No. ____________________________
Date of Application ___________________
COMMISSIONER OF BUSINESS OVERSIGHT
PURSUANT TO SECTION 28650 OF THE CORPORATIONS CODE
The Application for Requesting Approval to Surrender a Capital Access Company Law License
MUST BE TYPEWRITTEN and may only be filed in the Sacramento Office of the Department of
Business Oversight.
1.
Name of Applicant: ______________________________________________________
2.
Name under which business is conducted, if different from above:
______________________________________________________________________
3.
Address of actual location of principal place of business:
______________________________________________________________________
No. and Street
City
State
ZIP Code
4.
State the reason for surrendering the license:
______________________________________________________________________
5.
Does the applicant owe any money or securities to any investor?
Yes
No
If answer is “yes”, furnish all of the following information:
a.
Amount of money owed:
$_________________________________________
b.
Arrangements made for the payment of the money owed:
______________________________________________________________________
c.
Market value of securities (if applicable): ________________________________
d.
Arrangements made for the return or delivery of securities:
______________________________________________________________________
6.
Has applicant assigned any of its contracts to another person?
Yes
No
If answer is “yes” furnish all of the following information:
a.
Name and business address of the person(s) to whom the contracts were assigned:
______________________________________________________________________
b.
Name of contact person: ____________________________________________
c.
What alternative was provided with respect to those investors who did not
consent to the assignment of their contracts?
________________________________________________________________
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR REQUESTING APPROVAL TO SURRENDER CAPITAL
ACCESS COMPANY LAW LICENSE
DBO–280.200 (Rev. 10-17) Page 2 of 2
7.
Is applicant involved in any legal action or proceeding?
Yes
No
If “yes”, furnish complete information with respect to each.
8.
Are there any unsatisfied judgments or liens against applicant?
Yes
No
If “yes”, furnish complete information with respect to each.
9.
If the answer was “yes” to any questions in paragraphs 5, 6, 7, or 8 above, attach a
statement of financial condition. The Statement of financial condition must be prepared
in accordance with generally accepted accounting principles and must have been
prepared within 10 days of filing this application. Securities of the applicant in which
applicant has an interest must be listed in a separate schedule at market price, if any;
and if no current independent market exists the basis upon which value has been
assigned should be stated.
10.
Attach a copy of the closing audit. The closing audit must be performed by an
independent certified public accountant and must contain a statement specifying all
deficiencies, if any, noted by the accountant, with respect to all collections and
disbursements of funds, together with such information as the accountant may wish to
include (such as corrective steps taken with respect to any deficiency so noted), or
stating that no deficiencies were found.
11
Furnish below the name and address of the person who has or will have custody or
possession of applicant’s books and records which are required to be preserved
pursuant to Rules 280.650, 280.651, and 280.652 of Title 10 of the California Code of
Regulations.
____________________________________________________________________________
12
The applicant has duly caused this application to be signed on its behalf by the
undersigned, thereunder duly authorized.
______________________________
(Applicant)
By: __________________________
______________________________
(Title)
I certify or (declare) under penalty of perjury under the laws of the State of California that I have
read this application and the exhibits thereto a know the contents thereof, and that the
statements therein are true and correct.
Executed at _______________________, on ______________
(Place)
(Date)
_____________________________
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