COMMONWEALTH OF PUERTO RICO
OFFICE OF THE COMMISSIONER OF FINANCIAL INSTITUTIONS
PO BOX 11855
SAN JUAN, PR 00910-3855
LICENSE APPLICATION FOR LEASING COMPANIES
INSTRUCTIONS
1. Please answer all questions use a separate sheet if the space provided is not enough. If an item does not apply, state so with N/A.
2. All applicants are advised that this is an official document and that any misrepresentation or failure to reveal information requested may be deemed to be sufficient cause for the refusal or revocation of a license.
3. The application shall be filed with the following documents:
- Certified check or money order payable to the Secretary of the Treasury for $1,000.00.
- Financial Statements of the applicant prepared by a Certified Public Accountant.
- Declaration of Personal Background of the owner of the business. If it is a corporation, of each of its directors and owners. Include two 2x2 photographs of each of the persons and certifications of non-criminal record.
- If the applicant is a Corporation, include a Corporate Resolution authorizing the filing of the application.
- Applicant’s employer identification number.
- In case of a nonresident of Puerto Rico, the application must be accompanied by a document appointing a resident agent to represent the nonresident person in any judicial proceeding or to receive any legal notice.
- All applicants must establish an office in Puerto Rico.
- Certification from Puerto Rico State Department as authorized to do business in Puerto Rico.
- The forms with all the required documents must be mailed to:
OFFICE OF THE COMMISSIONER OF FINANCIAL INSTITUTIONS
LICENSING DIVISION
PO BOX 11855
SAN JUAN, PR 00910-3855
COMMONWEALTH OF PUERTO RICO
OFFICE OF THE COMMISSIONER OF FINANCIAL INSTITUTIONS
LICENSE APPLICATION
LICENSE TYPE: LEASING COMPANY
General Information
1. Name of Applicant / 6. Main Office address2. Commercial Name(D.B.A.) / 7. Mailing Address
3. Organization Type / 8. Estimated number of persons to be employed
4. Place of Incorporation:
5. Telephone Number / 9. If applicant is an individual indicate residential address
10. If applicant is a corporation, please provide the following information for its officers and Board of Directors.
Name / Address / Position
11. Name and address of the resident agent.
12. Provide the following information for stockholders who own 10% or more of the voting stock of the company. If the applicant is a subsidiary, indicate the name of the holding company and the information corresponding to its stockholders.
Name / Address / No. of shares and % owned
13. If applicant is a partnership indicate the following information for each partner:
Name / Address / Title
Additional Information
15. Have you or any person mentioned in this application had a license, certification or authorization denied, suspended or revoked by any federal agency? If yes, please furnish details.
16. Have you or any person mentioned in this application ever been convicted of a felony? If yes, please furnish details.
17. Describe applicant’s experience in this or any other type of business. If a corporation or partnership you may provide a resume for principal officers and directors or partners.
18. Indicate present relationship with other organizations.
19. Provide the following information for senior management including the general manager or person in charge of the office for which this license is requested.
Name / Title / Business Address
Information related to the office or branch to be established
20. Indicate physical address of the office or branch where business will be conducted.21. Indicate other businesses which will be conducted at applicant’s premises or at other locations.
Business Type / Location
I,______, do solemnly swear that the foregoing answers and statements, together with those in all exhibits attached hereto, have been knowingly made by me and that the same are true and correct, and that I have not omitted to state any material fact bearing upon such matters.
Given under my hand this______day of ______of ______.
______
Authorized Person Signature
Include a Corporate Resolution certified by the secretary of the corporation indicating that the signer of this application is an authorized officer.
AFFIDAVIT NUMBER______
Subscribed and sworn before me by______of legal age and resident of ______personally known to me. Given at ______this ____day of______of______.
STAMP
______
Notary Public
If notary is a resident of another State or jurisdiction a certification from such State or jurisdiction must be included indicating the expiration date of his/her commission.
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