Sec. 15.7. Collateral loan broker's registration and supplemental registration statement

Each and every collateral loan broker is required to file with the State Comptroller the following registration and supplemental registration statement. For filing each collateral loan broker's registration statement, a fee of $5; and for filing each supplemental statement, a fee of $2.50. Such fees are payable at the time of filing and no filing shall be deemed effective within the meaning of this section until such fees have been paid.

1. Fee

 

$5.00

2. Date ____

COLLATERAL LOAN BROKER'S REGISTRATION STATEMENT

Article 5 of the General Business Law provides:

Section 53. After September First, Nineteen Hundred Sixty, no person, corporation, firm or association shall carry on the business of collateral loan broker within the State of New York unless and until such collateral loan broker shall have caused to be filed in the office of the State Comptroller upon forms prescribed by him a statement, duly verified as hereinafter provided, to be known as “Collateral Loan Broker's Registration Statement.”

3. (Print Full Name)

 

(Trade Name)

4. (Street Address of Principal Office)

 

(P.O. Address)

5.

 

(Address of Licensed Premises)

6. (Business Phone No.)

7. Check Type of Organization: Individual □ Partnership □ Corporation □

8. Individual: Answer No. 16.

9. Partnership: Answer No. 16.

10. Corporation: Answer No. 17.

11. (Name and Location of Licensing Body)

12. Date Collateral Loan Broker's License was Issued

 

13. Collateral Loan Broker's License No.

 

14. State whether any other business will be carried on in said premises:

Yes □ No □

15. If “Yes,” give details.

 

 

16. The following to be filled in only by Individual or Partnership Registrant:

 

NAME

 

RESIDENCE

 

(If Partnership, Name each Partner)

 

 

 

 

 

 

 

 

 

 

 

 

The undersigned, each for himself, certifies that he is the Registrant above named; that he knows the contents of the above registration and the statements contained therein and the same are true of his own knowledge; that the Registrant will comply with the rules and regulations of the Department of Audit and Control pertaining to collateral loan brokers that are now in force or that may in the future be promulgated.

DATED ___________

 

 

 

 

 

 

 

 

 

(Signature of Individual or Each Partner)

17. The following questions are to be answered only by a Corporation Registrant:

a) Name of Corporation

 

b) Was Corporation Organized in New York State _ Date Inc. _

c) If Not, did Corporation obtain Certificate of Authority to do Business in this State Yes or No

d) Date of Certificate

 

e) State Principal Place of Business (Address—City and State)

f) The Names and Addresses of All Officers of Corporation:

Name

Residence

Business Address

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THIS CERTIFICATE TO BE SIGNED AND DATED BY A CORPORATION

 

certifies that he is (Title) of the above

named corporation; that he knows the contents of the above registration and the statements and answers therein; that the same are true of his own knowledge; that he has been authorized, by order of the Board of Directors of said Corporation to make the statements and answers as contained in this registration; that the registrant will comply with the rules and regulations of the Department of Audit and Control pertaining to collateral loan brokers that are now in force or that may in the future be promulgated.

DATED

 

 

(Signature of Authorized Officer)

STATE OF NEW YORK

 

1.

Fee

 

$2.50

DEPARTMENT OF AUDIT AND CONTROL

 

2. Date ____

COLLATERAL LOAN BROKER'S SUPPLEMENTAL REGISTRATION STATEMENT

Article 5 of the General Business Law provides:

Section 53(f)—In the event that after any collateral loan broker shall have filed a “Collateral Loan Broker's Registration Statement,” any change shall take place in the personnel of the Partners, Principals, Officers or in the location of the Principal, such collateral loan broker shall file a statement with the State Comptroller to be known as a “Collateral Loan Broker's Supplemental Registration Statement.”

3. (Print Full Name)

 

(Trade Name)

4. (Street Address of Principal Office)

 

(P.O. Address)

5.

 

(Address of Licensed Premises)

6. (Business Phone No.)

7. Check Type of Organization: Individual □ Partnership □ Corporation □

8. Individual—Answer No. 16.

9. Partnership—Answer No. 16.

10. Corporation—Answer No. 17.

11. (Name and Location of Licensing Body)

12. Date Collateral Loan Broker's License was Issued

 

13. Collateral Loan Broker's License No.

 

14. State whether any other business will be carried on in said premises:

Yes □ No □

15. If “Yes,” give details.

 

 

16. The following to be filled in only by Individual or Partnership Registrant:

 

NAME

 

RESIDENCE

 

(If Partnership, Name each Partner)

 

 

 

 

 

 

 

 

 

 

 

 

The undersigned, each for himself, certifies that he is the Registrant above named; that he knows the contents of the above registration and the statements contained therein and the same are true of his own knowledge; that the Registrant will comply with the rules and regulations of the Department of Audit and Control pertaining to collateral loan brokers that are now in force or that may in the future be promulgated.

DATED ___________

 

 

 

 

 

 

 

 

 

(Signature of Individual or Each Partner)

17. The following questions are to be answered only by a Corporation Registrant:

a) Name of Corporation

 

b) Was Corporation Organized in New York State _ Date Inc. _

c) If Not, did Corporation obtain Certificate of Authority to do Business in this State Yes or No

d) Date of Certificate

 

e) State Principal Place of Business (Address—City and State)

f) The Names and Addresses of All Officers of Corporation:

Name

Residence

Business Address

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THIS CERTIFICATE TO BE SIGNED AND DATED BY A CORPORATION

 

certifies that he is (Title) of the above

named corporation; that he knows the contents of the above registration and the statements and answers therein; that the same are true of his own knowledge; that he has been authorized, by order of the Board of Directors of said Corporation to make the statements and answers as contained in this registration; that the registrant will comply with the rules and regulations of the Department of Audit and Control pertaining to collateral loan brokers that are now in force or that may in the future be promulgated.

DATED

 

 

(Signature of Authorized Officer)