Statement Of Identity And Questionnaire {DFPI-512-SIQ}

DFPI-512 SIQ - STATEMENT OF IDENTITY AND QUESTIONNAIRE.This form is used by the California Department of Financial Protection and Innovation (DFPI) to collect detailed background information about individuals associated with a licensee, typically for those seeking or holding licenses in industries like escrow, finance, or securities. This form is designed to assess the applicant's qualifications, legal history, and eligibility for licensure. It asks for personal information such as name, address, employment history, and details about any prior legal issues, including judgments, court actions, bankruptcy, or criminal convictions. The form also inquires about previous business licenses, name changes, bond history, and potential involvement in escrows. It is specifically required for individuals applying for roles like escrow officers, managers, or directors within an escrow company, or those involved in escrow transactions. The form includes a verification section to ensure that all information provided is truthful and accurate, with penalties for false statements. It emphasizes confidentiality of the information and provides guidance on how personal data will be used and protected under state and federal laws. www.FormsWorkflow.com