Nh Branch Office Form - State Of New Hampshire Banking Department printable pdf download

State of New Hampshire

Banking Department

53 Regional Drive, Suite 200

Concord, NH 03301

Telephone: (603) 271-3561

Fax: (603) 271-

0750

Licensing: (603) 271-8675

NH BRANCH OFFICE FORM INSTRUCTIONS

A. GENERAL INSTRUCTIONS

FILING – The NH Branch Office form should be used to apply to license a branch office location, and to change any information about a

licensed branch office location and to surrender or otherwise terminate a branch office license. There is no fee to file an amendment or

to terminate a license. If the name of the licensee or the address of the branch is being amended, submit the original branch office

licenses to the Department along with this form; new licenses will be issued and sent to the licensee.

TERMS USED – See the following Explanation of Terms section regarding italicized words/phrases.

EXECUTION – The execution section must be completed by an authorized representative of the applicant or licensee (corporate officer,

partner, member, sole proprietor, etc).

DATES – The filing date is the date applicant or licensee submits this form to New Hampshire. The effective date is the date applicant or

licensee would like this license or amendment to become effective.

AMENDMENTS – Using this form, the applicant or licensee must update information about a branch office on a continuing basis.

Changes of address and branch closings need to be reported ten (10) days prior to the change or closing. Other changes, including the

addition or removal of a branch manager, should be reported within thirty (30) days from the date of the event that requires an amendment

filing. When filing an amendment, check the “amendment” box on line 1, provide the applicant/licensee’s name, filing and effective dates,

and complete only the information that is being amended in item(s) 2a through 5a or 6 through 14.

CONTACT EMPLOYEE – The individual listed on the applicant’s/licensee’s License Application Form (company’s main office) as the

contact employee will be contacted by the New Hampshire Banking Department if needed, about this branch form filing.

SURRENDER / CLOSE– When an applicant/licensee decides to cease operations under the license at one or more branches, use a NH

Branch Office Form to notify New Hampshire of each closing by checking the “surrender” box and completing only items 2, and 6 and the

execution. Send the original license certificate to the New Hampshire Banking Department along with the NH Branch Office Form to

surrender. Use the NH Surrender/Expiration Form to notify New Hampshire if the entire company will cease operations in New Hampshire

under its license. When terminating a branch license, it is necessary to enclose the original license issued by the NHBD with the NH

Branch Office Form filing.

B. FILING INSTRUCTIONS

FORMAT

The NH Branch Office Form may accompany a new company filing on the License Application Form, or may follow the License

Application Form later. A fully completed NH Branch Office Form must be submitted to New Hampshire when the applicant/licensee

is filing for branch authorization/licensure for the first time.

The execution section must include an original manual signature under penalty of unsworn falsification pursuant to NH RSA 641:3.

C. Type or print all information.

D. Use only the current version of the NH Branch Office Form or a reproduction of it.

ATTACHMENTS

File an Individual Disclosure Form, a Criminal History Record Information Authorization Form, fingerprint card and a fee in the amount

of $51.50 made payable to “State of NH – Criminal Records”, for each branch manager identified in item 5 and 5a of this NH Branch

Office Form.

B. Submit copies of any written agreements or contracts between the applicant/licensee and any NH branch office.

C. EXPLANATION OF TERMS – The following terms are italicized throughout the NH Branch Office form

APPLICANT/LICENSEE – The company that is newly applying on or amending information on this form for a branch license. The only

instance in which the applicant/licensee is an individual is in the case of a sole proprietorship.

JURISDICTION - The federal government, a foreign government, a state, the District of Columbia, the Commonwealth of Puerto Rico, or any

subdivision or regulatory body thereof.

FINANCIAL SERVICES OR FINANCIAL SERVICES-RELATED – Pertaining to securities, commodities, banking, insurance, consumer

lending, debt adjustment, money transmission 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, mortgage servicer, closing agent, title company, or escrow agent).

PERSON – An individual, partnership, corporation, trust, or other organization.

Nh Branch Office Form - State Of New Hampshire Banking Department

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