Fillable Printable Acbo Application
Fillable Printable Acbo Application
Acbo Application
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
INFORMATION ON THE APPLICATION FORTHE PILOT PROGRAM FORAFFORDABLE
CREDIT-BUILDING OPPORTUNITIES UNDER THE CALIFORNIA FINANCE LENDERS LAW
DBO – CFL 1581(Rev. 11-13)
CFL 1581 Information (Rev. 11/13)
1
The following is provided as general information for financelenders licensed under the California Finance
Lenders Law who wish to participate in the Pilot Program for Affordable Credit-Building Opportunities in
acc ordanc e w ith Fina ncia l Co de Se ctio n 22 349.
GENERAL INFORMATION
Senate Bill 1146 (Chap. 640, S tats. 2010) was signed into law on Septemb er 30, 2010 and is operative Januar y 1,
2011. The bill created th e Pilot Pro gram for Affordable Cr edit-Building Opportunities to increase the availability
of affordable short-term credit and to expand credit-building opportunities for individuals.
Finan ce lend ers who are licens e und er the Cali forn ia Finan ce Len ders Law and app roved b y the Commissionerof
Business Oversightto participate in the program may charge specified alternative interest rates and charges,
including an administrative fee and delinquency fees, on loans of at least $250 and less than $2,500, subject to
certai n req uiremen ts . Li c en se es p art icipating in th e p ro g ram ar e al so p erm i t t ed t o u se t h e s e rvi c es of a “fin de r” as
defined in Section 22353(b) of the Financial Code.
APPLICATION TO PARTICIPATE IN THE PROGRAM
•An application form to participate in the program may be obtained from any office of the Department of
Business Oversight and from the website at www.dbo.ca.gov. The office locations are as follows:
320 W. 4
th
Street, Suite 750Los Angeles, CA 90013
One Sansome Street, Suite 600 San Francisco, CA 94104
1515 K Street, Suite 200 Sacramento, CA 95814
1350 Front Street, Room 2034 San Diego, CA 92101
•Questions regarding completing and filing an application should be directed to 1-866-275-2677.
•Completed applications must be filed with the Los Angeles office. The application MUST be
accompanied by NON REFUNDABLE fees as follows.
NUMBER OF LICENSED
FINANCE LENDER LOCAT IONS
APPLICATION FEE
1 to 10
$250
11 to 50
$450
51 to 100
$650
Over 100
$850
•Within 30 Calendar days from the receipt of the application, the Commissioner of Business Oversight
shall inform the applicant in writing, that the application is complete and the licensee is approved to
participate in the program or disapproved, and if disapproved, the reason(s) for disapproval; or that the
application is deficient and specify what information is required to complete the application.
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
INFORMATION ON THE APPLICATION FORTHE PILOT PROGRAM FORAFFORDABLE
CREDIT-BUILDING OPPORTUNITIES UNDER THE CALIFORNIA FINANCE LENDERS LAW
DBO – CFL 1581(Rev. 11-13)
CFL 1581 Application (Rev. 11/13)
2
APPLICATION FOR THE PILOT PROGRAM FOR
AFFORDABLE CREDIT-BUILDING OPPORTUNITIES
FOR LENDERS LICENSED UNDER THE
CALIFORNIA F INANCE LENDERS LAW
1. Name of Licensee:
_________________________________________________________________________________
Fictitious Business Name:
_________________________________________________________________________________
2. CFLL License Number: _______________________________
Primary Mailing (988) Number, if applicable: ______________
3. Mailing Address: __________________________________________________________________
__________________________________________________________________
4. Contact Person/Title: _______________________________________________________________
5. Telephone Number: ________________________ Email Address: ______________________
6. Are you in good standing with the Commissioner of Business Oversight? Yes No
If no, please attach an explanation, marked as Exhibit 1, and any documentation.
7. Do you have any outstanding enforcement actions or deficiencies with any government agenc y at the time of
this application?Yes No
If yes, please attach an explanation, marked as Exhibit 2, and documentation of the enforcement actions or
deficiencies.
8. Has your credit education program or seminar been approved by the Commissionerof Business Oversightas
required under Section 22352(g)(1) of the Financial Code?
Yes , approved by the Commissioner of Business Oversight on [ ] (month/day/year)
No , attached is the credit education program or seminar, marked as Exhibit 3, for the Commissionerof
Business Oversig ht's review and approval.
No , the credit education program or seminar will be submitted to the Commissione rof Business Oversightfor
review and approval at a later time. Licensee shall not offer any credit education program or seminar that has not
been previously reviewed and approved bythe Commissionerof Business Oversightfor use, and licensee shall not
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
INFORMATION ON THE APPLICATION FORTHE PILOT PROGRAM FORAFFORDABLE
CREDIT-BUILDING OPPORTUNITIES UNDER THE CALIFORNIA FINANCE LENDERS LAW
DBO – CFL 1581(Rev. 11-13)
CFL 1581 Application (Rev. 11/13)
3
disburse loan proceeds to a borrower prior to offering an approved credit education program or seminar to the
borrower.
9. Are you a data furnisher with a national credit reporting agency? Yes No
If yes, provide the following information:
Name of Credit Reporting Agency Date Accepted
____________________________________ _________________________
____________________________________ _________________________
____________________________________ _________________________
10. Will you report to a national credit reporting agency the payment performance of each borrower on all loans
made under this prog ram as required under Se ct ion 223 52(g )( 2) of the F ina nc ial Co de ?
Yes No
11. Do you plan to use the services of a finder as defined under Section 22353(b) of the Financial Code?
Yes
No
If yes, pl eas e at t ach a l is t o f the nam e of t he f i nd er(s ), marked as Exhibit 4 , an d a com pl et ed N o ti ficat i on t o
Commissioner of Finder Registration for each finder, marked as Exhibit 5.
12. Provide the social security number of the applicant if an individual (sole proprietor), or the federal
taxpayer identification number if a business entity other than a sole proprietorship, marked as Exhibit 6. The
Department of Business Oversight is required to collect from all applicants social security numbers under
Family Code Section 17520, and social security numbers or federal taxpayer identification numbers under
Business and Professions Code Section 494.5. The social security number or federal taxpayer identification
number is used to match the informationt o the names on the list provided b y the Department of Child S upport
Services under Family Code Section 17520, and the lists of tax delinquencies provided by the State Board of
Equalization and the Franchise Tax Board under Business and Professions Code Section 494.5. Any disclosed
social security numbers or federal taxpayer identification numbers in the completed application will be
considered confidential information, and will be filed and maintained as part of the confidential records not
subject to public inspection. Refer to Commissioner’s Release 2-G for further information concerning privacy
protection of personal information.
The licensee has duly caused this application to be signed on its behalf by the undersigned, thereunto duly authorized.
The undersigned, on behalf of the licensee, acknowledges that this application and all exhibits theretowhich are not
designated as confidentialare subject to publi c inspection pursuant to S ection 250.9.1, C hapter 3, Title 10, Cali fornia
Code of Regulations. A request for confidentiality of certain documents may be requested pursuant to Section
250.10. If a request for c onfide ntial treatment is granted (or deni ed), the person makin g such request will be notified
in writing.
The undersigned also acknowledges on behalf of the licensee that the State Board of Equalization and the
Franchise Tax Board are authorized to share taxpayer information with the Department of Business Oversight,
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
INFORMATION ON THE APPLICATION FORTHE PILOT PROGRAM FORAFFORDABLE
CREDIT-BUILDING OPPORTUNITIES UNDER THE CALIFORNIA FINANCE LENDERS LAW
DBO – CFL 1581(Rev. 11-13)
CFL 1581 Application (Rev. 11/13)
4
and in the event the state tax obligation is not paid by a licensee after a license is issued, the Department of
Business Oversight may be required to suspend the license (Business and Professions Code Sections 31 and
494.5).
I declare und er penalty of perjury that I have read the foregoing application, including Exhibits attached thereto, or
filed therewith, and know the contents thereof, and that the statements therein are true an d corre ct. I furt her declare,
on behalf of the licensee, that I have read and understand the Financial Code and regulations pertaining to the
California Finance Lenders Law and the Pilot Program for Affordable Credit-Building Opportunities under the
Califor n ia F inan ce Len ders Law.
___________________________________
(Licensee)
Executed at _______________________ ___________________________________
(City, County, and State) (Signature of Declarant)
Date _____________________________ ___________________________________
(Typed Name of Declarant)
___________________________________
(Title)
