Cal. Code Regs. Tit. 10, § 95.5030 - Authorization for Release of Information

Current through Register 2021 Notice, Register No. 40, October 1, 2021

The following is an illustration of Department Form DBO 5030:

Form 5030 (8-12-15)

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STATE OF CALIFORNIA - DEPARTMENT

OF BUSINESS OVERSIGHT

AUTHORIZATION

FOR RELEASE OF INFORMATION

(MONEY TRANSMITTERS)

DBO 5030

AUTHORIZATION FOR RELEASE OF INFORMATION

________________________________________________________________

(Name of Applicant)

(hereinafter referred to as the "Applicant"), which is applying for a license under the Money Transmission Act (California Financial Code, Division 1.2, commencing with Section 2000), hereby irrevocably authorizes any bank or other financial institution with which the Applicant may at any time transact business and any governmental agency which licenses or regulates money transmitters or other financial institutions and which at any time has information or records regarding the Applicant, to furnish to the Commissioner of Business Oversight of the State of California such information, and to permit her/him to inspect and copy such records, as she/he may request from time to time.

Dated: ____________________ ______________________________
(Name of Applicant)
By____________________________
(Signature)
______________________________
(Name and Title)

(Note: The signature of the Applicant must be acknowledged.)

Notes

Cal. Code Regs. Tit. 10, § 95.5030

Note: Authority cited: Sections 321 and 334, Financial Code. Reference: Section 2032, Chapter 3, Division 1.2 and Section 33903, Financial Code.

1. Change without regulatory effect adding new section filed 8-19-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 34).
2. Amendment of section and Note filed 8-11-2015; operative 10-1-2015 (Register 2015, No. 33).

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