"Mortgage Loan Modification Services Provider Registration Application Form" - Delaware

This Delaware-specific printable "Mortgage Loan Modification Services Provider Registration Application Form" is a part of the legal paperwork issued by the Delaware Department of Justice.

Download the up-to-date PDF by clicking the link below and mail it as per the guidelines provided by the department.

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Download "Mortgage Loan Modification Services Provider Registration Application Form" - Delaware

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BEFORE THE DIRECTOR OF THE CONSUMER PROTECTION DIVISION
OF THE DEPARTMENT OF JUSTICE
IN RE:
)
)
)
Applicant’s Business Name
)
Application No. ______________
)
)
)
)
)
)
)
Applicant’s Facility Address
)
)
)
Date of Application
)
Mortgage Loan Modification Services Provider Registration Application
Effective March 21, 2012, no person may provide mortgage loan modification services to an individual
who it reasonably should know resides in Delaware unless that person is properly registered with the
Consumer Protection Unit of the Department of Justice. In order to be properly registered, a person must
1) complete the following form; 2) pay an application fee of $1,000.00; 3) and be issued and maintain a
certificate of registration.
It is unlawful to act as a Mortgage Loan Modification Services Provider by taking any action specified in
the Delaware Mortgage Loan Modification Services Act, until you have been issued a certificate of
registration from the Department of Justice, Attorney General's Office.
Application fees should be made payable to: The Consumer Protection Fund. The completed application
form, fee, and all required exhibited should be sent to:
Mortgage Loan Modification Services Provider Program
Delaware Attorney General' s Office Consumer Protection Unit
th
820 N. French Street, 5
Floor
Wilmington, DE 19801
Each application must answer all questions and attach all required information. Additional pages may
be included in the application if needed.
Page 1 of ____
BEFORE THE DIRECTOR OF THE CONSUMER PROTECTION DIVISION
OF THE DEPARTMENT OF JUSTICE
IN RE:
)
)
)
Applicant’s Business Name
)
Application No. ______________
)
)
)
)
)
)
)
Applicant’s Facility Address
)
)
)
Date of Application
)
Mortgage Loan Modification Services Provider Registration Application
Effective March 21, 2012, no person may provide mortgage loan modification services to an individual
who it reasonably should know resides in Delaware unless that person is properly registered with the
Consumer Protection Unit of the Department of Justice. In order to be properly registered, a person must
1) complete the following form; 2) pay an application fee of $1,000.00; 3) and be issued and maintain a
certificate of registration.
It is unlawful to act as a Mortgage Loan Modification Services Provider by taking any action specified in
the Delaware Mortgage Loan Modification Services Act, until you have been issued a certificate of
registration from the Department of Justice, Attorney General's Office.
Application fees should be made payable to: The Consumer Protection Fund. The completed application
form, fee, and all required exhibited should be sent to:
Mortgage Loan Modification Services Provider Program
Delaware Attorney General' s Office Consumer Protection Unit
th
820 N. French Street, 5
Floor
Wilmington, DE 19801
Each application must answer all questions and attach all required information. Additional pages may
be included in the application if needed.
Page 1 of ____
1) List the Corporate/Business Name of the Mortgage Loan Modification Services Provider ("MLMSP"):
2) List all other names used or to be used by the MLMSP:
3) If the MLMSP is a corporation or LLC, list the name and title of all officers or members:
4) If the MLMSP is not a corporation, list the name(s) of all owner(s) of the MLMSP:
5) List the MLMSP's main mailing address:
Page 2 of ____
6) List all address(es), in addition to the MLMSP's main mailing address, used or proposed to be used by
the MLMSP:
7) List the MLMSP's main telephone number(s):
8) List all telephone number(s) used or proposed to be used by the MLMSP:
9) List all Internet website(s) used or proposed to be used by the MLMSP:
10) List all e-mail address(es) used or proposed to be used by the MLMSP:
The Mortgage Loan Modification Service Provider (MLMSP) must provide each of the following
items with this application, labeled as the appropriate exhibit number (check those you are
attaching):
EXH. 1
A written script of all telephonic or broadcast advertising and other statements used or proposed to be
used by the MLMSP in connection with acting as a MLMSP.
EXH. 2
A copy of all print or electronic advertising and other promotional material used or proposed to be used
by the MLMSP in connection with acting as a MLMSP
Page 3 of ____
EXH. 3
A copy of each different contract, and any forms to be attached to the contract, used or proposed to be
used by the MLMSP with the MLMSP's clients.
EXH. 4
A copy of a currently effective surety bond in the amount of one hundred thousand dollars ($100,000),
executed by a corporate surety admitted to do business in this state, The person provides an original
corporate surety bond, with surety provided by a corporation authorized to transact business in this State,
in the principal sum of $100,000. The bond shall run to the State for the benefit of the Attorney General
and for the benefit of all consumers injured by any wrongful act, omission, default, fraud or
misrepresentation by such person in the course of its activity authorized by this chapter.
EXH.5
A statement signed by either the President of the MLMSP, if it is a corporation, or the primary owner of
the MLMSP business, if it is not a corporation, which states that the person has not been liable under any
civil judgment for fraud, misrepresentation, or violations of Delaware Law. An officer, director, member
or owner of the applicant has been convicted of a crime, or suffered a civil judgment, involving
dishonesty;
EXH.6
Enclosed is a check in the amount of $1000.00, for the Mortgage Loan Modification Services Provider
application fee.
FOR ANY ITEMS THAT ARE NOT ATTACHED, PLEASE STATE WHY SUCH ITEMS
HAVE NOT BEEN PROVIDED:
YOUR REGISTRATION APPLICATION CANNOT BE PROCESSED UNTIL ALL THE
INFORMATION AND ALL DOCUMENTS REQUIRED HAVE BEEN PROVIDED.
REMINDER- Registration must be renewed annually by using the renewal form and
submitting a renewal fee in the amount of $500.
Page 4 of ____
AFFIDAVIT
State of __________________________________)
) SS.
County of ________________________________)
I, the undersigned, swear or affirm that:
1. I have carefully read this Application for registration as a mortgage loan modification
services provider, including all attachments and forms. The information contained herein
is the product of a diligent and reasonable investigation and is true, accurate and
complete to the best of my information and belief;
2. I am a high managerial agent of the Applicant acting with the authority of the Applicant;
and
3. I understand that if I intentionally made a false statement in this application, or if
someone else made a false statement that I know or believe to be false, I may be subject
to criminal prosecution.
_______________________________________
Signature of Affiant
_______________________________________
Print Name of Affiant
______________________________________
Title
Sworn or affirmed and subscribed to before me this ______ of _____________________,
20_____.
_______________________________________
Notary Public
SEAL
My commission expires: ____________________
Page 5 of ____
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