Request For Consent To Transfer An Interest In An Escrow Agents License {DFPI-EL 17213}

DFPI–EL 17213 - REQUEST FOR CONSENT TO TRANSFER AN INTEREST IN AN ESCROW AGENT’S LICENSE.This form is used by the California Department of Financial Protection and Innovation (DFPI) to request approval for transferring ownership interests in an escrow agent’s license. This form must be completed when an escrow company proposes to change ownership, either through the transfer of stocks, securities, or other interests. It requires detailed information, including the name of the escrow agent and any former names, along with a description of the interests being transferred, specifying the type and number of securities involved. The form also requires the names and addresses of both the transferors (current owners) and transferees (new owners), including the percentage of outstanding shares being transferred. Additionally, the principal executive office address of the escrow agent must be provided, as well as contact details for the person who should receive correspondence regarding the transfer request. The form includes signature sections for both the transferors and transferees, along with a declaration under penalty of perjury that the information provided is true. A privacy notice on the form explains how personal information will be used and disclosed according to the California Financial Code and the Information Practices Act of 1977. www.FormsWorkflow.com