Form DBO-CSCL104 "Application for Business License" - California

What Is Form DBO-CSCL104?

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-CSCL104 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-CSCL104 "Application for Business License" - California

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STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR BUSINESS LICENSE
DBO-CSCL 104 (Rev. 10-17)
(Department of Business Oversight Use Only)
DEPARTMENT OF BUSINESS OVERSIGHT
Fee Paid $
File No.
Receipt No.
BEFORE THE
DEPARTMENT OF BUSINESS OVERSIGHT
OF THE
STATE OF CALIFORNIA
In the matter of the application of
)
)
)
)
For a License to engage in the business of
)
)
(Check as applicable)
(a) Check Seller
(b) Bill Payer
(c) General Prorater
(d) Special Prorater, (business agent)
This application must be accompanied by the fees required under Section 12214 (a), California Financial
Code, as follows:
Application Fee
$200
Investigation Fee
50
Total Fees
$250
Note: The above fees are not refundable if the application is withdrawn or denied.
A Check Seller applicant shall furnish a license bond on a form approved by the Commissioner in the
amount of $500,000 pursuant to Section 12205(b) of the Financial Code. In lieu of providing this bond, an
applicant may deposit with the Commissioner cash in the form and manner prescribed in Section 12206.1
(FC). Bill payers and Proraters shall furnish a license bond in the amount of $25,000.
In addition to the above, Check Sellers and Bill Payers are required to submit a fidelity bond in a minimum
amount of $50,000; for General and Special Proraters, the minimum is $10,000.
A Check Seller must have tangible net worth of at least $500,000, including liquid assets of at least
$150,000. A Bill Payer, General Prorater or Special Prorater must have tangible net worth of at least
$10,000 including liquid assets of at least $5,000.
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR BUSINESS LICENSE
DBO-CSCL 104 (Rev. 10-17)
(Department of Business Oversight Use Only)
DEPARTMENT OF BUSINESS OVERSIGHT
Fee Paid $
File No.
Receipt No.
BEFORE THE
DEPARTMENT OF BUSINESS OVERSIGHT
OF THE
STATE OF CALIFORNIA
In the matter of the application of
)
)
)
)
For a License to engage in the business of
)
)
(Check as applicable)
(a) Check Seller
(b) Bill Payer
(c) General Prorater
(d) Special Prorater, (business agent)
This application must be accompanied by the fees required under Section 12214 (a), California Financial
Code, as follows:
Application Fee
$200
Investigation Fee
50
Total Fees
$250
Note: The above fees are not refundable if the application is withdrawn or denied.
A Check Seller applicant shall furnish a license bond on a form approved by the Commissioner in the
amount of $500,000 pursuant to Section 12205(b) of the Financial Code. In lieu of providing this bond, an
applicant may deposit with the Commissioner cash in the form and manner prescribed in Section 12206.1
(FC). Bill payers and Proraters shall furnish a license bond in the amount of $25,000.
In addition to the above, Check Sellers and Bill Payers are required to submit a fidelity bond in a minimum
amount of $50,000; for General and Special Proraters, the minimum is $10,000.
A Check Seller must have tangible net worth of at least $500,000, including liquid assets of at least
$150,000. A Bill Payer, General Prorater or Special Prorater must have tangible net worth of at least
$10,000 including liquid assets of at least $5,000.
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR BUSINESS LICENSE
DBO-CSCL 104 (Rev. 10-17) Page 2 of 5
For the purpose of securing a license under the Check Sellers, Bill Payers and Proraters Law, applicant
sets forth the following sworn statements of fact:
1.
Principal office:
(Number and Street)
(City)
(County)
(Zip Code)
2.
Branch offices and mobile units:
(Number and Street)
(City)
(County)
(Zip Code)
(Number and Street)
(City)
(County)
(Zip Code)
(Number and Street)
(City)
(County)
(Zip Code)
3.
Agency locations:
(Name)
(Number and Street) (City)
(County)
(Zip Code)
(Name)
(Number and Street) (City)
(County)
(Zip Code)
(Name)
(Number and Street) (City)
(County)
(Zip Code)
4.
Applicant is organized and will do business as a:
(a) Individual (Special Prorater Only)
(b) California corporation, date of incorporation
5.
Detailed statement of the proposed plan of business:
[Refer to Section 12216(a)(2)(FC)]
6.
Detailed statement of plan of business applicant is presently engaged in:
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR BUSINESS LICENSE
DBO-CSCL 104 (Rev. 10-17) Page 3 of 5
7.
Names and addresses of all officers and directors; and also any employees having access to trust
funds:
President:
(Name)
(Number and Street)
(City)
(Zip Code)
Vice President:
(Name)
(Number and Street)
(City)
(Zip Code)
Secretary:
(Name)
(Number and Street)
(City)
(Zip Code)
Treasurer:
(Name)
(Number and Street)
(City)
(Zip Code)
Directors:
(Name)
(Number and Street)
(City)
(Zip Code)
(Name)
(Number and Street)
(City)
(Zip Code)
(Name)
(Number and Street)
(City)
(Zip Code)
Employees:
(Name)
(Number and Street)
(City)
(Zip Code)
(Name)
(Number and Street)
(City)
(Zip Code)
(Name)
(Number and Street)
(City)
(Zip Code)
(Name)
(Number and Street)
(City)
(Zip Code)
NOTE: ATTACH AN EXHIBIT WHERE SPACE IS NOT SUFFICIENT
8.
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. The following exhibits should be submitted unless previously
filed with the Commissioner:
(a)
Exhibit . A corporate resolution and/or of the minutes of the directors' meeting authorizing
the filing of this application, and any other minutes of directors' or shareholders' meetings
relating to the operation of the business to be licensed.
(b)
Exhibit
. A statement of identity and questionnaire, Department's Form FS 512 SIQ, and
a personal financial statement for each of the persons named on item 7 above. Please
indicate which one of the above officers is to be considered as applicant's principal
managing officer:
Please refer to Sections 12216(a)(1), 12221 (e) and 12331
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR BUSINESS LICENSE
DBO-CSCL 104 (Rev. 10-17) Page 4 of 5
(c)
Exhibit
. A copy of the articles of incorporation or of agreement of organization and any
amendments thereto.
(d)
Exhibit
. A copy of any by-laws and amendments thereto.
(e)
Exhibit
. A complete itemized report of applicant's financial condition as of a recent date,
showing the amount and character of its assets and liabilities. If the financial statement is
unaudited, it must be verified and signed. If applicant is a Corporation, the unaudited
financial statement must be verified and signed by a majority of the applicant's directors.
(f)
Exhibit
. A copy of each form or document to be used in the proposed business of the
applicant.
(g)
Exhibit
. A scheduled of fees to be charged by applicant.
(h)
Exhibit . A statement from each officer, director, or general partner, or sole proprietor, and
every managing employee that he or she has read and is familiar with the Check Sellers,
Bill Payers and Proraters Law (Financial Code) and the Commissioner's Rules (Code of
Regulations).
9.
Please answer the following questions:
(a)
Has applicant or any of its officers or directors ever been named in any Order, Judgement,
or Decree of any court, temporarily or permanently, restraining it or enjoining it from
engaging in or continuing any conduct, practice, or employment; or has applicant ever been
convicted of any misdemeanor or felony, or has applicant ever been held liable for fraud in
any civil action, or refused a license to engage in business in this state, or any other State,
or has any such license held ever been suspended or revoked?
Yes
No
If "Yes," attach details as an exhibit.
(b)
Has applicant ever done business under a fictitious firm name?
Yes
No
If "Yes," attach details as an exhibit.
10.
Applicant is aware of the provisions of Section 3700 of the Labor Code, which requires every
employer to be insured against liability for Workmen's Compensation.
(Name of Workmen's Compensation Insurance Carrier)
11.
Applicant hereby states that it will maintain in effect insurance reasonably covering possible loss of
money or property in its possession by holdup or burglary.
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
APPLICATION FOR BUSINESS LICENSE
DBO-CSCL 104 (Rev. 10-17) Page 5 of 5
WHEREFORE, your applicant prays that this application be filed and that a license be issued by the said
Commissioner of Business Oversight authorizing applicant to engage in business pursuant to the
provisions of the Check Sellers, Bill Payers and Proraters Law.
(Applicant)
By
(Title)
VERIFICATION
STATE OF
)
COUNTY OF
)
, being first duly sworn, deposes and says: That he is an officer
of the applicant making the foregoing application, to wit, the
thereof; that he has
read the same, including all the exhibits attached thereto, to be filed therewith, and knows the contents
thereof, and that the statements made therein are true of his own knowledge except as to matters therein
stated on his information or belief, and that as to matters therein stated on his information or belief, and
that as to those matters he believes them to be true.
Dated
(Signature of Affiant)
Subscribed and sworn to before me
This
day of
,
Notary Public in and for the County
Of
State of
Affirmation under penalty of perjury may be used in lieu of verification if execution takes place in the State
of California.
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