Authenticated PDF Version
2100 Mortgage Loan Brokers
2106 Report of Delaware Assets
5 Del.C. §§2111 and 2112
Effective Date: April 11, 2014
Each licensee shall submit this report annually to the Office of the State Bank Commissioner. This report must be received no later than April 1 of each year and must contain information for the previous calendar year. The information reported should reflect DELAWARE assets only (including the value of any Delaware loans or contracts, any funds deposited in Delaware, and any fixed assets located in Delaware or any other assets allocated to the Delaware operations).
A completed, signed report may be scanned and submitted by e-mail to email@example.com no later than April 1.
Failure to submit this report when due will be a violation of this regulation. In addition, an examination may be scheduled and examination staff allocated without respect to the licensee’s amount of Delaware assets. This may result in additional examination costs.
1. Name of Licensee: _______________________________________________________
2. Address of Principal License: _______________________________________________
3. To whom should we mail the supervisory assessment invoice? Please provide name, title, complete mailing address, telephone number (include area code and extension numbers, if applicable) fax number and e-mail address:
4. DELAWARE assets as of December 31st of the immediately previous year:
Delaware Loans and Contracts
Funds Deposited in Delaware
Fixed Assets in Delaware
Other Delaware Assets
I, the undersigned officer, hereby certify that this report is true and correct to the best of my knowledge and belief.
_____________ _________________________________ ________________________
Date Signature Title
Printed Name Phone Number
17 DE Reg. 994 (04/01/14)