Immigration Consultant Disclosure - California Secretary Of State Page 2
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1
2Instructions for Completing the Immigration Consultant Disclosure Form
For easier completion, this form is available on the Secretary of State's website at
programs/special-filings and can be viewed, filled in and printed from your computer. The completed form can
be mailed to Secretary of State, Special Filings Unit, P.O. Box 942870, Sacramento, CA 94277-2870. If you are
not completing this form online, please type or legibly print in black or blue ink. This form should not be altered.
This form is filed only in the Sacramento office.
An immigration consultant is required to file an Immigration Consultant Disclosure form with the Secretary of State, along with
a surety bond, and must pass a background check prior to engaging in the business or acting in the capacity of an
immigration consultant. An immigration consultant must notify the Secretary of State’s office in writing within 30 days when
the surety bond is renewed, and of any change of name, address, telephone number, or agent for service of process.
Statutory provisions for this disclosure form are found in Business and Professions Code section 22443.1. There is no fee to
file the disclosure form.
Along with the completed disclosure form, it is necessary to submit the following items:
Copy of valid and current photo identification. Acceptable forms of identification are:
1. An identification card or driver’s license issued by the California Department of Motor Vehicles.
2. A passport issued by the Department of State of the United States.
3. An identification card issued by a state other than California.
4. A driver’s license issued by a state other then California.
5. An identification card issued by any branch of the armed forces of the United States.
2” x 2” passport photo.
Complete the Immigration Consultant Disclosure form as follows:
Items 1-6. Enter the name, date of birth (month, day and year), residence and business addresses, and residence and
business telephone numbers (including area code) of the immigration consultant.
Item 7.
Check “Yes” or “No” if the immigration consultant has ever been convicted of a violation of Section 6126 (relating
to the unauthorized practice or attempted practice of law without a license) or of Division 8, Chapter 19.5 of the
Business and Professions Code (relating to immigration consultants).
Item 8.
Check “Yes” or “No” if the immigration consultant has ever been arrested or convicted of a crime, including a
crime dismissed under Penal Code section 1203.4 or 1203.4a.
Item 9.
Enter the name of the immigration consultant’s agent for service of process in California, if any. An agent is an
individual who resides in California designated to accept any legal documents that may be served upon the
immigration consultant.
Item 10.
If an agent for service of process is entered, enter the individual’s business or residence street address in
California. Do not enter “in care of” (c/o) or abbreviate the name of the city. A post office box is not acceptable.
Items 11-13. If the immigration consultant is employed by a corporation or partnership, enter the name, business addresses,
and business telephone number (including area code) of the corporation or partnership.
Item 14.
If the immigration consultant is employed by a corporation or partnership, enter the name of the agent for service
of process in California of the corporation or partnership. An agent is an individual who resides in California or a
corporation designated to accept any legal documents that may be served upon the corporation or partnership. If
a corporation is designated as agent, that corporation must have a current certificate filed with the Secretary of
State pursuant to Corporations Code section 1505. If an individual is designated as agent, complete Items 14 and
15. If a corporation is designated as agent, complete Item 14 only and proceed to Item 16 (do not complete Item
15).
Item 15.
If an individual is designated as agent for service of process, enter a business or residence address in California.
Do not enter “in care of” (c/o) or abbreviate the name of the city. Do not enter an address if a Section 1505
corporation is designated as agent. A post office box is not acceptable.
Item 16.
Type or print the name of the immigration consultant signing the form and enter the date the form was completed
and signed.
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