An
application for registration shall be signed under penalty of false statement and
include:
(1)The applicant's name, principal business address and telephone number,
and all other business addresses in this state, electronic-mail addresses, and
internet website addresses;
(2)All names under which the applicant conducts business;
(3)The address of each location in this state at which the applicant will
provide debt-management services or a statement that the applicant will have no
such location;
(4)The name and home address of each officer and director of the applicant
and each person that owns at least ten percent of the applicant;
(5)Identification of every jurisdiction in which, during the five years
immediately preceding the application:
(A)The applicant or any of
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An
application for registration shall be signed under penalty of false statement and
include:
(1) The applicant's name, principal business address and telephone number,
and all other business addresses in this state, electronic-mail addresses, and
internet website addresses;
(2) All names under which the applicant conducts business;
(3) The address of each location in this state at which the applicant will
provide debt-management services or a statement that the applicant will have no
such location;
(4) The name and home address of each officer and director of the applicant
and each person that owns at least ten percent of the applicant;
(5) Identification of every jurisdiction in which, during the five years
immediately preceding the application:
(A) The applicant or any of its officers or directors has been licensed or
registered to provide debt-management services; or
(B) Individuals have resided when they received debt-management services
from the applicant;
(6) A statement describing, to the extent it is known or should be known by
the applicant, any material civil or criminal judgment or litigation and any material
administrative or enforcement action by a governmental agency in any jurisdiction
against the applicant, any of its officers, directors, owners, or agents, or any person
who is authorized to initiate transactions to the trust account required by section 5-19-222;
(7) The applicant's financial statements, audited by an accountant licensed
to conduct audits, for each of the two years immediately preceding the application
or, if it has not been in operation for the two years preceding the application, for the
period of its existence;
(8) A description of the three most commonly used educational programs
that the applicant provides or intends to provide to individuals who reside in this
state and a copy of any materials used or to be used in those programs;
(9) A description of the applicant's financial analysis and initial plan,
including any form or electronic model, used to evaluate the financial condition of
individuals. The description shall be deemed to be confidential commercial data
under section 24-72-204 (3)(a)(IV).
(10) A copy of each form of agreement that the applicant will use with
individuals who reside in this state;
(11) The schedule of fees and charges that the applicant will use with
individuals who reside in this state;
(12) At the applicant's expense, the results of a state and national
fingerprint-based criminal history record check, conducted within the immediately
preceding twelve months, covering every officer of the applicant and every
employee of the applicant who is authorized to initiate transactions to the trust
account required by section 5-19-222. The administrator shall be the authorized
agency to receive information regarding the result of the national criminal history
record check. If a provider delegates to an independent contractor or subcontractor
the authority to initiate transactions to the trust account required by section 5-19-222, the administrator is entitled to receive the results of the state and national
fingerprint-based criminal history record check only for those independent
contractors or subcontractors who are authorized to initiate trust account
transactions pursuant to that delegated authority.
(13) The names and addresses of all employers of each director during the
five years immediately preceding the application; except that if a director receives
no compensation from the provider, the applicable period shall be two years. The
names and addresses shall be deemed to be confidential.
(14) A description of any ownership interest of at least ten percent by a
director, owner, or employee of the applicant in:
(A) Any affiliate of the applicant; or
(B) Any entity that provides products or services to the applicant or any
individual relating to the applicant's debt-management services;
(15) For not-for-profit providers, a statement of the amount of compensation
of the applicant's five most highly compensated employees for each of the three
years immediately preceding the application or, if it has not been in operation for
the three years immediately preceding the application, for the period of its
existence;
(16) The identity of each director who is an affiliate, as defined in section 5-19-202 (2)(A) or (2)(B)(i), (2)(B)(ii), (2)(B)(iv), (2)(B)(v), (2)(B)(vi), or (2)(B)(vii), of the
applicant; and
(17) Any other information that the administrator reasonably requires to
perform the administrator's duties under section 5-19-209.