Form DBO-SLS100 "Supplemental Request for Information - Student Loan Servicing Program" - California

What Is Form DBO-SLS100?

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 May 1, 2018;
  • 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-SLS100 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-SLS100 "Supplemental Request for Information - Student Loan Servicing Program" - California

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STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
SUPPLEMENTAL REQUEST FOR INFORMATION
DBO–SLS 100 (Rev. 5-18)
STATE OF CALIFORNIA
DEPARTMENT OF BUSINESS OVERSIGHT
STUDENT LOAN SERVICING PROGRAM
Supplemental Request for Information Required for Licensure
Under the Student Loan Servicing Act (Financial Code section 28100, et seq.)
NAME OF APPLICANT:
_____________________________________________________
NAME OF PRIMARY CONTACT EMPLOYEE:
____________________________________________________
EMAIL ADDRESS FOR PRIMARY CONTACT EMPLOYEE:
_____________________________________________________
APPLICANT’S MAILING ADDRESS:
___________________________________________________________
(street address)
___________________________________________________________
(city, state and zip code)
Financial Code section 28144(a), of the Student Loan Servicing Act, requires each student loan servicer
licensee to “pay to the commissioner its pro rata share of all costs and expenses reasonably incurred
in the administration of this division, as estimated by the commissioner, for the ensuing year and any
deficit actually incurred or anticipated in the administration of the division in the year in which the
assessment is made. The pro rata share shall be the proportion that a licensee’s servicing activities in
this state bears to the costs and expenses remaining, in excess of $250.00 assessed per licensed
location per year.”
Financial Code section 28104(f) defines “in this state” as “any activity of a person relating to servicing
student loans that originates from this state and is directed to persons outside this state, or that
originates from outside this state and is directed to persons inside this state, or that originates inside
this state and is directed to persons inside this state.”
Please provide the information requested below for servicing activities in this state, as of the prior year
end. This information is required and will be used to calculate your organization’s Annual Assessment
for the year in which you become licensed. For ensuing years, this same information will be required
annually, and submitted as part of the licensee’s annual report.
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
SUPPLEMENTAL REQUEST FOR INFORMATION
DBO–SLS 100 (Rev. 5-18)
STATE OF CALIFORNIA
DEPARTMENT OF BUSINESS OVERSIGHT
STUDENT LOAN SERVICING PROGRAM
Supplemental Request for Information Required for Licensure
Under the Student Loan Servicing Act (Financial Code section 28100, et seq.)
NAME OF APPLICANT:
_____________________________________________________
NAME OF PRIMARY CONTACT EMPLOYEE:
____________________________________________________
EMAIL ADDRESS FOR PRIMARY CONTACT EMPLOYEE:
_____________________________________________________
APPLICANT’S MAILING ADDRESS:
___________________________________________________________
(street address)
___________________________________________________________
(city, state and zip code)
Financial Code section 28144(a), of the Student Loan Servicing Act, requires each student loan servicer
licensee to “pay to the commissioner its pro rata share of all costs and expenses reasonably incurred
in the administration of this division, as estimated by the commissioner, for the ensuing year and any
deficit actually incurred or anticipated in the administration of the division in the year in which the
assessment is made. The pro rata share shall be the proportion that a licensee’s servicing activities in
this state bears to the costs and expenses remaining, in excess of $250.00 assessed per licensed
location per year.”
Financial Code section 28104(f) defines “in this state” as “any activity of a person relating to servicing
student loans that originates from this state and is directed to persons outside this state, or that
originates from outside this state and is directed to persons inside this state, or that originates inside
this state and is directed to persons inside this state.”
Please provide the information requested below for servicing activities in this state, as of the prior year
end. This information is required and will be used to calculate your organization’s Annual Assessment
for the year in which you become licensed. For ensuing years, this same information will be required
annually, and submitted as part of the licensee’s annual report.
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
SUPPLEMENTAL REQUEST FOR INFORMATION
DBO–SLS 100 (Rev. 5-18) Page 2 of 2
Information Required as Part of Application for License
Number of
Dollar Volume of
st
As of the previous December 31
Borrowers
Loans
Servicing activity originated in California, directed to
person outside California
Servicing activity originated outside California,
directed to person inside California
Servicing activity originated in California, directed to
person in California
CUMULATIVE TOTALS
0
$ 0.00
The applicant has duly caused this application to be signed on its behalf by the undersigned, duly
authorized representative.
I certify/declare under penalty of perjury under the laws of the State of California that I have read this
Supplemental Request for Information and know the contents thereof, and that the statements therein
are true and correct.
Executed at ____________________________ (city and state), on this __ day of _____, 20 ____.
By: _______________________________
Signature
__________________________________
Print Name of Signatory
___________________________________
Title
Page of 2