Looking for a California Legal Forms And Templates? Download it for free!

Form Cacl 280.151 - Facing Page For Application For A License Under The Capital Access Company Law Page 10

EXECUTION PAGE

Please indicate the name, address, title, and telephone number of the person who should be contacted for information

regarding this application. The license will be mailed to this person unless otherwise instructed.

Attention: ___________________________________________________________________

(Name)

(Title)

(Telephone Number)

_____________________________________________________________________

(Number and Street)

(City)

(State)

(Zip Code)

In the event of the issuance of a license, applicant agrees to comply with the requirements of the Capital Access

Company Law and rules adopted, and orders issued, by the Commissioner of Corporations, and further agrees that in

the event of any change of its officers, directors, or any persons named in this application, that a verified amendment to

the application reflecting such change shall within fifteen business days from the date of the change, be filed with the

Commissioner of Corporations setting forth the change, the effective date of the change, the names of the persons

involved in the change, and a statement of the qualifications of each successor person.

WHEREFORE, applicant requests that a license be issued by the Commissioner of Corporations authorizing applicant

to engage in business under the Capital Access Company Law within the State of California.

The applicant has duly caused this application to be signed on its behalf by the undersigned, thereunto duly authorized.

Applicant: _____________________

By: ___________________________

______________________________

(Typed Name)

______________________________

(Title)

The undersigned, on behalf of the applicant, acknowledges that this application and all exhibits thereto which are not

designated as confidential are subject to public inspection pursuant to Section 250.9.1, Chapter 3, Title 10, California

Code of Regulations. A request for confidentiality of certain documents may be requested pursuant to Section 250.10.

If a request for confidential treatment is granted (or denied), the person making such request will be notified in writing.

I certify (or declare) under penalty of perjury that I have read the foregoing application, including all Exhibits attached

thereto, or filed therewith, and know the contents thereof, and that the statements therein are true and correct

Executed at __________________

____________________________

(Signature of Declarant)

Date _______________________

______________________________

(Typed Name)

IF EXECUTED OUTSIDE THE STATE OF CALIFORNIA, ATTACH A VERIFICATION EXECUTED

AND SWORN TO BEFORE A NOTARY PUBLIC.

Form Cacl 280.151 - Facing Page For Application For A License Under The Capital Access Company Law Page 10