Form ICC3 "Idaho Consumer Lender Branch Office Application Form" - Idaho

What Is Form ICC3?

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

Form Details:

  • Released on February 1, 2019;
  • The latest edition provided by the Idaho Department of Finance;
  • 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 printable version of Form ICC3 by clicking the link below or browse more documents and templates provided by the Idaho Department of Finance.

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Download Form ICC3 "Idaho Consumer Lender Branch Office Application Form" - Idaho

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Mail:
Overnight:
Idaho Department of Finance
Idaho Department of Finance
P.O. Box 83720
800 Park Blvd., Ste 200
Boise, Idaho 83720-0031
Boise, Idaho 83712
208/332-8000
IDAHO REGULATED CONSUMER LENDER BRANCH OFFICE APPLICATION FORM
TO BE USED FOR BOTH IN-STATE AND OUT-OF-STATE LOCATIONS
FORM ICC3 INSTRUCTIONS
A. GENERAL INSTRUCTIONS
1. FILING – Form ICC3 is the Branch Office form accompanying the Form ICC1-Regulated Consumer Lender Application
form. An applicant for a Regulated Consumer Lender license may apply for a branch office simultaneously with the ICC1
or at a later date.
2. TERMS USED – See the following Explanation of Terms section regarding italicized words/phrases.
3. EXECUTION – The execution section must be completed by an authorized representative of the applicant (corporate
officer, partner, member, sole proprietor, etc).
4. AMENDMENTS – The applicant must update information about a branch office by submitting amendments using Form
ICC3. When filing an amendment, check the “amendment” box on line 1, provide the applicant name, filing and effective
dates, and complete only the information that is being amended in item(s) 2a through 6a or 7 through 14. Return the
original license document when submitting the amended Form ICC3.
5. CONTACT EMPLOYEE – The individual listed on the applicant’s Form ICC1 (company’s main office) as the contact
employee will be contacted if needed, about this branch form ICC3.
6. SURRENDER / CLOSE– When an applicant decides to cease operations under the license, at one or more branches, use
the Form ICC3 to notify the Department of Finance by checking the “surrender” box and completing only items 2, and 7.
Send the original license document along with the Form ICC3 to surrender. Use the Form ICC1 to notify the Department
if the entire company will cease operations under the license.
B. FILING INSTRUCTIONS
1. FORMAT
A. Form ICC3 may accompany a new company filing on Form ICC1, or may follow the Form ICC1 later. A fully
completed Form ICC3 for each location (unless multiple locations are submitted simultaneously) must be submitted to
the Department of Finance when the applicant is filing for a branch license.
B. The Execution section must include notarized original manual signature and notary for the initial Form ICC3 filing for
each branch office.
C. Type or print legibly all information.
D. Use only the current version of Form ICC3.
2. ATTACHMENTS
A. $350 Application Fee per location, per license type, payable to the Idaho Department of Finance
B. File a Form ICC2 for each branch manager identified in item 6 and submit a verification of experience containing a
detailed history of related job descriptions/duties for the past 10 years. Job titles or lending volumes alone do not meet
this requirement.
C. Submit a file-stamped copy of an Idaho Secretary of State issued Certificate of Filing ABN for each fictitious business
name/trade name/doing business as name(s) that the applicant desires to use in Idaho, if not already of record.
D. FINANCIAL RESPONSIBILITY –Submit current bank statements, in the name of the applicant entity, dated within
30 days of application. The bank statements must reflect a minimum of $30,000 in liquid assets
available for the purpose of making loans. A current bank or depository statement(s), signed by an authorized signer
of the depository institution, on depository institution letterhead, may also be submitted for liquidity purposes.
Payday Lender Applicants-- The bank statements must reflect a minimum of $30,000 in liquid assets for the main
office, to be increased an additional $5,000 for each additional Idaho physical location, up to a maximum of $75,000.
A current bank or depository statement(s), signed by an authorized signer of the depository institution, on depository
institution letterhead, may also be submitted for liquidity purposes.
The financial responsibility requirements are ongoing in nature.
Form ICC3, Idaho Rev 2/2019
Page 1 of 4
Mail:
Overnight:
Idaho Department of Finance
Idaho Department of Finance
P.O. Box 83720
800 Park Blvd., Ste 200
Boise, Idaho 83720-0031
Boise, Idaho 83712
208/332-8000
IDAHO REGULATED CONSUMER LENDER BRANCH OFFICE APPLICATION FORM
TO BE USED FOR BOTH IN-STATE AND OUT-OF-STATE LOCATIONS
FORM ICC3 INSTRUCTIONS
A. GENERAL INSTRUCTIONS
1. FILING – Form ICC3 is the Branch Office form accompanying the Form ICC1-Regulated Consumer Lender Application
form. An applicant for a Regulated Consumer Lender license may apply for a branch office simultaneously with the ICC1
or at a later date.
2. TERMS USED – See the following Explanation of Terms section regarding italicized words/phrases.
3. EXECUTION – The execution section must be completed by an authorized representative of the applicant (corporate
officer, partner, member, sole proprietor, etc).
4. AMENDMENTS – The applicant must update information about a branch office by submitting amendments using Form
ICC3. When filing an amendment, check the “amendment” box on line 1, provide the applicant name, filing and effective
dates, and complete only the information that is being amended in item(s) 2a through 6a or 7 through 14. Return the
original license document when submitting the amended Form ICC3.
5. CONTACT EMPLOYEE – The individual listed on the applicant’s Form ICC1 (company’s main office) as the contact
employee will be contacted if needed, about this branch form ICC3.
6. SURRENDER / CLOSE– When an applicant decides to cease operations under the license, at one or more branches, use
the Form ICC3 to notify the Department of Finance by checking the “surrender” box and completing only items 2, and 7.
Send the original license document along with the Form ICC3 to surrender. Use the Form ICC1 to notify the Department
if the entire company will cease operations under the license.
B. FILING INSTRUCTIONS
1. FORMAT
A. Form ICC3 may accompany a new company filing on Form ICC1, or may follow the Form ICC1 later. A fully
completed Form ICC3 for each location (unless multiple locations are submitted simultaneously) must be submitted to
the Department of Finance when the applicant is filing for a branch license.
B. The Execution section must include notarized original manual signature and notary for the initial Form ICC3 filing for
each branch office.
C. Type or print legibly all information.
D. Use only the current version of Form ICC3.
2. ATTACHMENTS
A. $350 Application Fee per location, per license type, payable to the Idaho Department of Finance
B. File a Form ICC2 for each branch manager identified in item 6 and submit a verification of experience containing a
detailed history of related job descriptions/duties for the past 10 years. Job titles or lending volumes alone do not meet
this requirement.
C. Submit a file-stamped copy of an Idaho Secretary of State issued Certificate of Filing ABN for each fictitious business
name/trade name/doing business as name(s) that the applicant desires to use in Idaho, if not already of record.
D. FINANCIAL RESPONSIBILITY –Submit current bank statements, in the name of the applicant entity, dated within
30 days of application. The bank statements must reflect a minimum of $30,000 in liquid assets
available for the purpose of making loans. A current bank or depository statement(s), signed by an authorized signer
of the depository institution, on depository institution letterhead, may also be submitted for liquidity purposes.
Payday Lender Applicants-- The bank statements must reflect a minimum of $30,000 in liquid assets for the main
office, to be increased an additional $5,000 for each additional Idaho physical location, up to a maximum of $75,000.
A current bank or depository statement(s), signed by an authorized signer of the depository institution, on depository
institution letterhead, may also be submitted for liquidity purposes.
The financial responsibility requirements are ongoing in nature.
Form ICC3, Idaho Rev 2/2019
Page 1 of 4
C. EXPLANATION OF TERMS – The following terms are italicized throughout Form ICC3
APPLICANT – The finance entity applying on or amending information on this form for a branch license/registration. The only
instance in which the applicant is an individual is in the case of a sole proprietorship.
FINANCIAL SERVICES OR FINANCIAL SERVICES-RELATED – Pertaining to securities, commodities, banking, insurance,
consumer lending, or real estate (including, but not limited to, acting as or being associated with a bank or savings
association, credit union, mortgage lender, mortgage broker, real estate agent or broker, appraiser, closing agent, title
company, or escrow agent.
PERSON – An individual, partnership, corporation, trust, or other organization.
Form ICC3, Idaho Rev 2/2019
Page 2 of 4
IDAHO CONSUMER LENDER BRANCH OFFICE FORM
FORM ICC3
Regulated Lender
Title Lender Y
N
(Branch)
Regulated Lender” includes Assignee, Wholesale Mortgage Lenders,
Finance Companies, Title Lenders
Payday Lender
“Payday Lender” only authorizes payday lending
Mark appropriate box(es)
$350 per license type/per
location
Applicant full legal name:
:
WARNING
Failure to keep this form current and to file accurate supplementary information on a timely basis, or the failure to keep accurate
books and records or otherwise to comply with the provisions of law pertaining to the conduct of business for which you are
applying, may violate the laws of Idaho and may result in disciplinary, administrative, injunctive or criminal action.
NEW BRANCH APPLICATION
SURRENDER
AMENDMENT
1.
Complete only the item(s) being amended.
2a.
2.
Physical address (Number and Street)
NEW Physical address (Number and Street)
Physical City, State/Country, Zip+4/Postal Code
NEW Physical City, State/Country, Zip+4/Postal Code
3a.
3.
Mailing address or P.O. Box (if applicable)
NEW Mailing address or P.O. Box (if applicable)
Mailing address City, State/Country, Zip+4/Postal Code
NEW Mailing address City, State/Country, Zip+4/Postal Code
4a.
4.
Business (Area Code) and Telephone Number
NEW Business (Area Code) and Telephone Number
Fax (Area Code) and Number
NEW Fax (Area Code) and Number
Branch e-mail
NEW Branch e-mail
Branch website
NEW Branch website
5a.
5.
Trade name or “dba” used at this branch
NEW Trade name or “dba” used at this branch
6a.
6.
Branch Manager Name
NEW Branch Manager Name
Supervisor Name
NEW Supervisor Name
EXECUTION:
The undersigned, being first duly sworn, deposes and says that he/she is an officer of the applicant and has executed this
form on behalf of, and with the authority of, said applicant. The undersigned and applicant represent that the information and statements
contained herein, including exhibits attached hereto, and other information filed herewith, all of which are made a part hereof, are current, true
and complete. The undersigned and applicant further represent that to the extent any information previously submitted is not amended such
information is currently accurate and complete.
Date (MM/DD/YYYY)
Signature of authorized party
Title
Subscribed & Sworn before me
by
Print Notary Public name
Print authorized party name
Notary seal here
on this
day of
,
at
Month
Year
State
County
Notary Public Signature
Notary Appointment Expires (MM/DD/YYYY)
This execution must always be completed in full with original, manual signature and notarization. Affix notary stamp or seal where applicable.
Form ICC3, Idaho Rev 2/2019
Page 3 of 4
Applicant full legal name:
7.
Physical address of location where the official books and records generated by this branch office will be kept.
Organization Name (if different from applicant) or Records Custodian Name
Area Code
Telephone Number
Number and Street
City
State
Country
Zip+4/Postal Code
8
Mark the jurisdictions that applicant is currently applying to or is already licensed in for consumer lending purposes.
Alabama
Georgia
Maryland
New Mexico
South Dakota
Alaska
Guam
Massachusetts
New York
Tennessee
Texas – OCCC
Arizona
Hawaii
Michigan
North Carolina
Texas – SML
Arkansas
Idaho
Minnesota
North Dakota
California – DOC
Illinois
Mississippi
Ohio
Utah
California – DRE
Indiana
Missouri
Oklahoma
Vermont
Colorado
Iowa
Montana
Oregon
Virginia
Connecticut
Kansas
Nebraska
Pennsylvania
Washington
Delaware
Kentucky
Nevada
Puerto Rico
West Virginia
District of Columbia
Louisiana
New Hampshire
Rhode Island
Wisconsin
Florida
Maine
New Jersey
South Carolina
Wyoming
YES
NO
Will this branch office and/or individuals at this branch office operate pursuant to a written agreement or contract with
9.
the applicant’s main office? If “yes” provide a copy(ies) of the agreement(s)/contract(s).
YES
NO
Will this branch office have sole responsibility for decisions relating to individuals originating or soliciting consumer loans
10.
from this location:
(a) with respect to employment?
(b) with respect to compensation?
YES
NO
11. Does any person, other than the applicant, have responsibility, directly or indirectly, for paying the expenses of this
branch office or otherwise have a financial interest in this branch office or its activities?
(a) If yes, provide an explanation of the expense payment and/or financial interest arrangement:
(b)
If yes, provide the following information for each person responsible for the expenses or with a financial interest:
FULL LEGAL NAME
Address, City, ST, Zip
Telephone
SSN, IRS Tax
Separately
No. or Employer
Licensed?
(Individuals: Last Name, First Name, Middle
ID
YES
NO
Name)
Form ICC3, Idaho Rev 2/2019
Page 4 of 4
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