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Customer Authorization Of Disclosure Of Financial Records Form - California Department Of Corporations Page 2

STATE OF CALIFORNIA

DEPARTMENT OF CORPORATIONS

INSTRUCTIONS FOR CUSTOMER AUTHORIZATION

OF DISCLOSURE OF FINANCIAL RECORDS FORM

On the reverse is a Customer Authorization of Disclosure of Financial Records form. The

Commissioner of Corporations is authorized to require such authorization from certain

licensees and other persons pursuant to the authority cited in the first paragraph of the

form.

The form must be properly executed and submitted with the attached application for

license, qualification, registration or other authority.

All information required on the form, except the signature of the person executing the form,

is to be typewritten.

If the form requests a Department of Corporations' file number, the applicant need only

provide such number if it is known to the applicant and is the type of file number

appropriate for the license, qualification, registration or other authority applied for in the

attached application.

If additional authorization forms are needed, they may be obtained from any office of the

Department of Corporations, or accurate copies of the form may be utilized by applicants.

ADM 500.270(7/90)

Customer Authorization Of Disclosure Of Financial Records Form - California Department Of Corporations Page 2