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Last Revised 2/1/07 TERRITORY OF THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF BANKING AND INSURANCE LICENSE APPLICATION PROCEDURES FOR A MORTGAGE BROKER In order to complete the application process, the Applicant must provide the following information and any additional requested information for licensure: 1. A completed application along with supporting documentation, which must be returned to: The Division of Banking and Insurance Office of the Lieutenant Governor 5049 Kongens Gade St. Thomas, V.I. 00802-6487 2. A non-refundable application fee in the amount of $200.00 3. A license fee in the amount of $400.00 4. A tax clearance letter from the Bureau of Internal Revenue for all entities requesting licensure. 5. A police report for all principals and individuals who will be managing the affairs of the company. 6. A list of all banks or lending institutions with which the Applicant is acting as a Mortgage Broker. 7. In accordance with Section 363(h)(2) of Title 9 of the Virgin Islands Code, if the Applicant has not conducted business as a Mortgage Lender or Mortgage Broker in the U.S. Virgin Islands at any time during the three (3) calendar years immediately preceding the submission of the application for licensure, the Applicant is required to provide a surety bond in favor of the Government of the Virgin Islands in the amount of $25,000.00. (Surety bond must be issued by a surety company authorized to do business in the U.S. Virgin Islands and must be maintained for the duration of the Applicant’s licensure in the Virgin Islands.) 8. In accordance with Section 363(h)(3) of Title 9 of the Virgin Islands Code, if the Applicant has conducted business as a Mortgage Lender or Mortgage Broker in the U.S. Virgin Islands at any time during the three (3) calendar years immediately preceding the submission of the application for licensure, the Applicant is required to provide a sworn statement setting forth the total dollar amount of mortgage loans applied for and accepted or mortgage loans applied for, procured, and accepted by the applicant during the latest calendar year. Based on this sworn statement, the Applicant will be required to provide a surety bond in an amount ranging from $25,000.00 to $200,000.00 depending on the amount of loans outstanding and the number of offices to be established in the Territory. Last Revised 2/1/07 (Surety bond must be issued by a surety company authorized to do business in the U.S. Virgin Islands and must be maintained for the duration of the Applicant’s licensure in the Virgin Islands.) 9. Most recent audited financial statement for the Applicant prepared in accordance with generally accepted accounting principles with an opinion issued by an independent CPA. The financial statement must show, at a minimum, a tangible net worth of $25,000. If the Applicant does not have an audited financial statement, the enclosed Financial Statement Form may be used, in the interim, in lieu of the audited financials. 10. If the applicant is domiciled in the Territory and is a corporation, a properly executed Certificate of Incorporation must be obtained from the Division of Corporations and Trademarks, Office of the Lieutenant Governor of the U.S. Virgin Islands. If the applicant is a LLC, a properly executed Certificate of Existence must be obtained from that Division. Conversely, if the applicant is a Limited Partnership, a properly executed Certificate of Registration or a date stamped acknowledgement of receipt of the application for qualification must be obtained from that division. 11. A Certificate of Goodstanding or other evidence from the Division of Corporations and Trademarks, Office of the Lieutenant Governor of the U.S. Virgin Islands showing that the applicant is current in its filings and payment of fees with that division. 12. If the applicant is not domiciled in the Territory, a Letter of Certification or other evidence from the appropriate regulatory authority showing that applicant’s license to act as a mortgage broker in applicant’s home state is current. 13. The following information is also required if the applicant has been conducting business as a mortgage broker or lender in any of the 3 years immediately preceding the submission of this application: (Please note that if the applicant has been conducting business as a mortgage broker in the U.S. Virgin Islands, the applicant is required to provide the following information for only St. Thomas, St. Croix and St. John. Accordingly, each island is considered a separate location.) A.) The number and total dollar amount of mortgage loans which were originated or purchased by the applicant for the last 3 years. B.) The number and dollar amount of all loans where the applicant filed notices of intent to foreclose within the last 3 years, which includes the borrower’s address, income level and property location (St. Croix, St. Thomas, St. John if applicable). Note* The applicant must provide a breakdown of the information requested in items A and B listed above by: i.) the number and dollar amount of mortgage loans made to mortgagors who did not, at the time of the execution of the mortgage, intend to reside in the property securing the mortgage; and Last Revised 2/1/07 ii.) the number and dollar amount of mortgage loans and completed applications involving mortgagors or mortgage applicants grouped according to: i. property location (St. Croix, St. Thomas, St. John if applicable), ii. gender, and iii. income level. C.) The dollar amounts of all loans presently outstanding including a breakdown by location (St. Croix, St. Thomas, St. John if applicable). 12.) Questions pertaining to the requirements for licensure may be directed to the Division of Banking and Insurance at (340) 774-7166 or (340) 773-6459. 1 TERRITORY OF THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF BANKING AND INSURANCE LICENSE APPLICATION FOR A MORTGAGE BROKER I.) GENERAL INFORMATION A. Exact Legal Name of Applicant:_______________________________________________________ B. D/B/A, Fictitious or Trade Name to be Used:_____________________________________________ C. Business Address (Physical) _________________________________________________________ ______________________________________________________________________________________ Telephone No: _______________________________ Fax No: ______________________________ D. Residential Address (For applicants who are individuals.) __________________________________ (Applicant must execute and submit a biographical affidavit.) _______________________________________________________________________________________ Telephone No. _________________________________ E. Federal Taxpayer I.D. No: ___________________________________________________________ F. State or Country where Organized: ____________________________________________________ G. Date Organized: __________________________________________________________________ H. Date Admitted into the US, Virgin Islands, if Foreign Corp. or Assoc.:__________________________ I. Name and Address of VI Resident Agent:______________________________________________ (Individual must execute and submit a biographical affidavit) _______________________________________________________________________________________ J. Anticipated Opening Date of Business (if applicable): ______________________________________ K. Is the Applicant in any way affiliated with a bank, bank holding company, industrial loan and thrift company, or any other lending institutions? Yes______ No ________ L. If the answer to J is yes, identify and specify the affiliation__________________________________ _______________________________________________________________________________________ 2 II.) STATUS OF APPLICANT: (Check appropriate box.)  An Individual doing business  An individual doing business  A general partnership under own name an assumed/trade name SS#____________________  A corporation-V.I., corporate I.D. #  An association  A limited partnership _________________________________  A Limited Liability Company A trust  Other (describe) _____________________________ III.) Regulatory/Criminal/Civil Disclosure: A. Has the Applicant or any of its officers, managers or individuals with a financial interest in the Applicant’s business ever had a license suspended or revoked or been subject to an administrative action by a State or Federal Regulatory Agency? Yes________ No___________ (If yes, please provide details on a separate sheet.) B. Has the Applicant or any of its officers, managers or individuals with a financial interest in the Applicant’s business ever surrendered or been refused a license by any State or Federal Regulatory Agency? Yes________ No___________ (If yes, please provide details on a separate sheet.) C. Has the Applicant or any of its officers, managers or individuals with a financial interest in the Applicant’s business ever been charged or convicted of a crime or been involved in any criminal actions within the 10-year period immediately preceding this application? Yes_______ No______ (If yes, please provide details on a separate sheet.)(Additionally, please provide a police report from every jurisdiction in which each individual has resided in the last 10 years.) D. Has the Applicant or any of its officers, managers or individuals with a financial interest in the Applicant’s business ever been involved in any bankruptcy or receivership proceedings within the 10- year period immediately preceding this application? Yes___________ No_____________ (If yes, please provide details on a separate sheet.) E. Name of State(s) where the Applicant or its affiliates currently broker, originate or service first mortgage loans._______________________________________________________________ IV.) Personnel: List below the name, title, status and, if applicable, percent interest of each officer, general partner, director, member, and each shareholder for this business entity. “Officer” means chief executive and/or operation officer, president, executive or senior vice president, secretary or treasurer. “General Partner” refers to a general partner of a limited partnership or to a general partner of a general partnership who holds an interest of more than 10%. “Member” refers to a limited liability company or a non-corporate business association. 3 “Shareholder” means any shareholder owning or controlling 10% or more of any class of stock in the corporation. (If more space is required, please use an additional sheet.) (Additionally, please execute and attach a biographical affidavit for each individual listed.) Name Title/Status and/or % interest 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Individual Responsible for the US Virgin Islands Operations of the Applicant: ( ) Name Telephone No. Street Address _______________________________________________________________________________________ Mailing Address City State Zip Code V.) Operation and Record Retention A. Location of the principal U.S. Office of the Applicant ( ) Name Telephone No 4 Street Address City State Zip Code B. Location where official books and records of the Applicant are kept: Name Telephone No Street Address City State Zip Code C. Please identify all Virgin Islands office locations at which the business of the Applicant is or will be conducted. (Attach additional pages if necessary.) (***Note: A license is needed for each place of business. Additionally, pursuant to Section 368 of Title 9 of the Virgin Islands Code, an applicant must receive the written consent of the Banking Board prior to changing its place of business.) Name of Office Telephone No ___________________________________________________________________________________ Contact Person Telephone No Street Address City State Zip Code D. Location where pertinent loan documents are kept regarding loans closed in the US Virgin Islands: Name of Office Telephone No ___________________________________________________________________________________ Contact Person Telephone No Street Address City State Zip Code 5 VI.) CERTIFICATION The undersigned, being duly sworn according to law and under the penalties of perjury state that the information given in this application for a license as a Mortgage Broker is true and correct and that all estimates given are true estimates based upon facts which have been carefully considered and assessed. Name___________________________________________ Date____________ (Please Print) Signature _________________________________________________________ Title ______________________________________________________________ Subscribed and sworn to before me this ___day of ________, 200_____. SEAL __________________________________ Notary Public ***Applicant must promptly notify the Division of Banking & Insurance of any changes in the information reported on this application and any changes in the business operations of the Mortgage Broker. 1 BIOGRAPHICAL AFFIDAVIT Note: This affidavit must accompany the application for licensure as a Mortgage Broker or Lender (Print or Type) Name and Address of Applicant (Provide the name of the Mortgage Broker Mortgage Lender with which affiant is associated.) ________________________________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ In connection with the above named applicant, I herewith make representations and supply information about myself as hereinafter set forth. IF ANSWER IS “NONE” OR “NO EXCEPTIONS,” SO STATE. ***attach addendum or separate sheet if space is insufficient to answer any question fully*** 1. Affiant’s Full Name_________________________________________________ Title _____________________________________________________________ Citizenship ________________________________________________________ Marital Status____________ Social Security Number______________________ 2. Have you ever had your name changed?____________ If yes, provide your previous name and give the reason for the change _________________________ _________________________________________________________________ 3. Date of Birth_________________Place of Birth___________________________ Color of Hair________________Eyes__________Height_______Weight_______ 4. Education and Degrees High School_______________________________________________________ College________________________________________________________ Graduate or Professional__________________________________________ (List all educational institutions and locations) 5. Member of Professional Societies or Associations (List)_____________________ __________________________________________________________________ 6. Present position with the applicant _____________________________________ 6a. Affiant’s Business Address____________________________________________ Business Telephone___________________________________________ 7. I and/or members of my immediate family control directly or indirectly, or own legally or beneficially, 10% or more of the outstanding stock (in voting power) of the following companies:_____________________________________________ __________________________________________________________________ 7a. If any of the above stock is pledged or hypothecated in any way, please detail fully._____________________________________________________________ ______________________________________________________________ 8. Present Occupation Position or Title___________________________How Long?____________ Employer’s Name_______________________________________________ Address_______________________________________________________ How long with this employer?_____________Where?__________________ 9. Present employer may be contacted. Yes No (Circle one) Former employer may be contacted. Yes No (Circle one) 2 10. Other jobs, positions, directorates, or offices concurrently held at present ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 11. Complete Employment Record for Past 20 Years up to and including present jobs, positions, directorates or offices. *Resume may be substituted if it covers this 20-year period. Date Employer and Address Title _______________ ____________________________ _______________ _______________ ____________________________ _______________ _______________ ____________________________ _______________ 12. For the last 10 years, I have lived at the following address or addresses: Address City/State Date ____________________ ________________________ _______________ ____________________ ________________________ _______________ ____________________ ________________________ _______________ 13. Have you ever been discharged or requested to resign from any position? Yes  No If the answer is yes, furnish details. _______________________________ _________________________________________________________________ _________________________________________________________________ 14. Have you invested or do you expect to invest, if this application is approved, any capital in the business of the applicant, licensee or affiliate? Yes  No (If the answer is yes, furnish amount and nature of investment.) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 15. Have you ever been adjudicated as bankrupt? Yes No. If yes, explain fully. (Attach a separate sheet if necessary.)____________________________________ __________________________________________________________________ 16. Have you ever been in a position which required a fidelity bond? Yes No. If yes, explain fully. (Attach a separate sheet if necessary.)____________________ __________________________________________________________________ 16a. Were claims made on the bond? Yes No. If yes, explain fully. (Attach a separate sheet if necessary.)___________________________________________ __________________________________________________________________ 17. Have you ever been denied an individual or position schedule fidelity bond, or had a bond cancelled or revoked? Yes No. If yes, explain fully. (Attach a separate sheet if necessary.)__________________________________________________ __________________________________________________________________ __________________________________________________________________ 18. Have you ever been charged, convicted or had a sentence imposed, suspended or had pronouncement of a sentence suspended or been pardoned for conviction of, or pleaded guilty of or nolo contendere to any information or an indictment 3 charging any felony or charging a misdemeanor involving embezzlement, theft or larceny, mail fraud, or violating any laws, or been the subject of any disciplinary proceedings of any federal or state regulatory agency? Yes No. If yes, explain fully. (Attach a separate sheet if necessary.)_____________ __________________________________________________________________ 18a. Has any company been so charged, allegedly as a result of any action or conduct on your part? Yes No. If yes, explain fully. (Attach a separate sheet if necessary.)________________________________________________________ 19. During the last 10 years, have you ever been refused a professional, occupational, or vocational license issued by any public or governmental licensing agency or regulatory authority, or has such a license held by you ever been suspended or revoked? Yes No. If yes, explain fully. (Attach a separate sheet if necessary.)_________________________________________________________ __________________________________________________________________ 20. Do you presently hold or have you ever held in the past a professional, occupational or vocational license issued by a public or governmental licensing agency or regulatory authority? Yes No. If yes, please provide the state in which the license was issued, the date it was issued, the name of the issuing agency, the date terminated, and the reason for termination. (Attach a separate sheet if necessary.) ________________________________________________ ________________________________________________________________ _________________________________________________________________ 21. Have you ever been an officer, director, trustee, investment committee member, key employee, or controlling stockholder of a company which, while you occupied any such position or capacity with respect to it, became insolvent or was placed in conservatorship, or was enjoined from or ordered to cease and desist from violating any laws? Yes No. If yes, explain fully. (Attach a separate sheet if necessary.) _____________________ __________________________________________________________________ 22. Has a company of which you were an officer, director, or key management person at the time ever been denied or refused or voluntarily withdrawn its application or a license? (Attach a separate sheet if necessary.) ________________________ _________________________________________________________________ _________________________________________________________________ 23. Has the license to do business of any company of which you were an officer or director or key management person ever been suspended or revoked while you occupied such position? (Attach a separate sheet if necessary.) _______________ __________________________________________________________________ __________________________________________________________________ Dated and signed this __________day of _________________at ________________ I hereby certify under penalty of perjury that the foregoing statements are true and correct to the best of my knowledge and belief. 4 _______________________________ (Signature of Affiant) Personally appeared before me the above named_________________________________ personally known to me, who, being duly sworn, deposes and says that he/she executed the above instrument and that the statements and answers contained therein are true and correct to the best of his/her knowledge and belief. Subscribed and sworn to before me this _____day of ________________, 20_________ Signature of Notary Public______________________________________ NOTARY SEAL Notary Public authorized by law of the State of_________________ To administer oaths. My commission expires on_______________ OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF BANKING & INSURANCE #5049 KONGENS GADE ST. THOMAS, U.S. VIRGIN ISLANDS, 00802 MORTGAGE LENDER/BROKER LICENSE APPLICATION FINANCIAL STATEMENT Check One: ___ Corporation ___ Sole Proprietor ___ Partnership ___ L.L.C Applicant:___________________________________________________________________ Address:_____________________________________________________________________ Financial condition as of:_______________________________________________________ (Must be within 90 days of application) ASSETS LIABILITIES Cash on hand and in banks*$_____________ Notes payable to banks U.S. Government Securities$_____________ secured.…....$______________ Listed Securities…..………... $_____________ unsecured.…...$______________ Unlisted Securities………….$_____________ Notes Payable………………$______________ Accounts and Notes Receivable due* Accounts & Bills due ……..$_______________ Good………….$_____________ Accrued Interest, etc…….…$______________ Doubtful………$_____________ Taxes unpaid or accrued..…$______________ Real Estate Owned*………..$_____________ Mortgage payable on real estate $____________ Mortgage Owned……………$_____________ Chattel Mortgages & other liens Automobiles*……………….$______________ payable………………….$________________ Other Assets – Itemize*…...$______________ Other debts – Itemize……...$_________________ _________________________________________ ____________________________________________ _________________________________________ ____________________________________________ _________________________________________ ____________________________________________ _________________________________________ ____________________________________________ Total Assets…………….…..$_______________ Total Liabilities…..…………..$________________ NET WORTH……………..$______________ Office of the Lt. Governor λDivision of Banking & InsuranceλKongens Gade #5049λSt. Thomas, U.S. Virgin Islands λ00802 λ Phone (340) -774-7166 λFax (340)-774-9458 * Attach supporting documentation. Information cannot be older than 90 days. I swear or affirm that this Financial Statement has been prepared or carefully reviewed by me and constitutes a complete and correct statement. I further realize that any false responses are a crime and may result in denial of this application or later revocation of licensure/certification. NOTE: The owner, partners, LLC members, or corporate president and secretary must sign as duly authorized by resolution of the Board of Directors. By: _______________________________________________ (Signature) (Title) (Date) By: _______________________________________________ (Signature) (Title) (Date) By: _______________________________________________ (Signature) (Title) (Date) SATE OF___________________COUNTY OF_____________________:SS SUBSCRIBED AND SWORN TO BEFORE ME THIS ______DAY OF______________ SEAL ________________________________________ (Notary Signature) SURETY BOND ________________________________________________________________ KNOW ALL MEN BY THESE PRESENTS, That the undersigned…………………… ………………………………………………………………………as principal, of ……………………………and the undersigned………………………………………….. ………………………………………………, as surety, are held and firmly bound unto the Lieutenant Governor, Chairman of the Banking Board of the United States Virgin Islands, and his successors in office, as obligee, in the full and just sum of……………….........................................to which payment we bind ourselves and our respective successors and assigns jointly and severally by these presents. WHEREAS, the laws of the Government of the Virgin Islands of the United States, Title 9 of the Virgin Islands Code, require all Mortgage Lenders/Brokers to file with the Lieutenant Governor, a good and sufficient surety bond in a sum not less than Twenty- Five Thousand Dollars ($25,000.00). AND WHEREAS, the aforesaid principal,……………………………… desires to transact business within the Territory of the Virgin Islands of the United States and has been informed by the Chairman of the Banking Board, that he requires a bond in the amount of ……………….……………………………………..and does by this instrument furnish and file said bond. NOW, THEREFORE, the condition of the above bond is such that if the principal shall answer to the amount of the bond for all judgments, decrees or orders given, made or rendered against the principal by any court of the Virgin Islands of the United States for the payment of money, then this bond to be void and of no effect; otherwise, to remain in full force and effect. PROVIDED, HOWEVER, that the surety shall have the right to terminate its suretyship under this obligation by serving written notice of its election to do so upon the Lieutenant Governor, Chairman of the Banking Board, not less than ninety (90) days prior to the date on which the then existing license of the principal is to expire. Surety shall, however, remain liable hereunder for all judgments, decrees or orders given, made or rendered against the principal, based on obligations incurred during the period of surety- ship. IN WITNESS WHEREOF, the said principal and said surety have set their hands and affixed their seals this………………..day of……………………………20……………… Principal: Attest: ………………………………………………….. ……………………………………… By………………………………………………. Secretary (Officer) STATE OF ) COUNTRY OF )ss: On this the ………………………day of…………………………..20……………. before me the undersigned Notary personally appeared...………………………………… who acknowledged himself to be the………………………………………………………. of…………………………………….…………………, a corporation and that he, as such -2- …………………………………………….…………, being so authorized to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the corporation by himself as…………………………………………. In Witness Whereof I hereunto set my hand and official seal. _____________________________________ (Notary Public) Surety………………………………………… ATTEST: _____________________________ Secretary By……………………………………………. (Officer) STATE OF ) COUNTRY OF )ss: On this the……………………day of ………………………….., 20…..….……… before me the undersigned Notary personally appeared…………………………...……… who acknowledged himself to be the………………………………………………….…… of……………….……………...………………………., a corporation and that he, as such ……………………………………….., being so authorized to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the corporation by himself as………………………………………………………….. In Witness Whereof I hereunto set my hand and official seal. ________________________________________ (Notary Public)