ࡱ>  @ <bjbjʚʚ :ydddxddd84Tx.E0 4@@@{d4v-kCkCkCkCkCkC$FR IC5dC@@D.BBB@d@BBB.6de@$ @X/d\ALD<.EUII(exxIdeD B-CCx|3^x STATE OF SOUTH CAROLINA DEPARTMENT OF CONSUMER AFFAIRS CREDIT COUNSELING ORGANIZATION APPLICATION INSTRUCTIONS S.C. Code Ann. 37-7-101 et seq.  HYPERLINK "http://www.scconsumer.gov/" www.scconsumer.gov 803-734-4236 South Carolina Consumer Credit Counseling Act: A Credit Counseling Organization and its Credit Counselors serving South Carolina debtors must be licensed. An organization is a Credit Counseling Organization when providing or offering to provide consumers with credit counseling services for a fee, compensation, or gain, or in the expectation of a fee, compensation, or gain, including debt management plans. Credit Counseling Services means (1) receiving or offering to receive funds from a consumer for the purpose of distributing the funds among the consumers creditors in full or partial payment of the consumers debts; (2) improving or offering to improve a consumers credit record, history, or rating; (3) negotiating or offering to negotiate to defer or reduce a consumers obligations with respect to credit extended by others. Complete the Credit Counseling Organization License Application and all additional forms in their entirety. Incomplete, illegible, or faxed applications will not be accepted. Incomplete information could result in the delay or denial of your application. Please print or type the application information. Criminal Record Check: All individuals listed in Question #11 of the application must request a criminal record check from the State Police of the State of the individuals residence, unless otherwise stated or prohibited by law. The report must be forwarded directly from the State Police to the Department of Consumer Affairs. Reminder: Credit Counselors must also request a criminal record check. Credit Report: All individuals listed in Question #11 of the application must obtain a current (less than 90 days old) composite credit report. On the report, include the organizations name and SCDCA- Credit Counseling. Surety Bond: A surety bond in the amount of twenty-five thousand dollars ($25,000) or in an amount that equals or exceeds the total amount of South Carolina clients funds in the applicants trust account at the time of application, whichever is greater, is required. The Special Deposit Bond Form, which can be found on the Departments website, must be used. The name on the bond must exactly match the name of your organization as stated in the Articles of Incorporation or Articles of Organization. Fees: All fees must accompany the application. Application Fee - $100 per location A fee of $100 per location listed in Question # 7. All licenses expire annually on December 31st. Licenses are issued to the specific company location. Renewal notices will be mailed in August prior to expiration. Investigation Fee - $50 This is only required to accompany initial applications. Counselor Fee - $40 A fee of $40 per counselor listed on the organizations Supplemental Form B(s) (Counselor applications must also be submitted.) Continuing Education: Twelve (12) hours of Continuing Professional Education (CPE) must be earned by December 31st of every other year of licensure (every 2nd renewal/ even-numbered renewal). NO CPE is required for initial licensing. CPE is required for: (1) Owners, (2) A designee of a LLC or corporation and (3) Counselors. Make Checks Payable To: Send Completed Applications To: South Carolina Department of Consumer Affairs SCDCA Legal Division: Credit Counseling Questions: P.O. Box 5757 Carri Grube Lybarker, Staff Attorney~ 803-734-4297 Columbia, SC 29250-5757 Darlene Dinkins, Program Coordinator~ 803-734-4209  STATE OF SOUTH CAROLINA DEPARTMENT OF CONSUMER AFFAIRS CREDIT COUNSELING ORGANIZATION LICENSE APPLICATION S.C. Code Ann. 37-7-101 through - 122. www.scconsumer.gov 803-734-4236 DO NOT FAX THIS FORM See Application Instructions. Please Type or Print Legibly in Ink. Attach additional page(s) as necessary. GENERAL INFORMATION1.Full Name of Credit Counseling Organization (applicant): FORMTEXT      Federal Tax ID No.: FORMTEXT      (Sole proprietors without employees disregard)Trade Name  d/b/a: FORMTEXT      2.Applicant s Contact Person: FORMTEXT      3.Business Headquarters Address: FORMTEXT      (Street Address) FORMTEXT       FORMTEXT    FORMTEXT       FORMTEXT      (City)(State)(Zip Code)(County)Mailing Address: FORMTEXT      (Street Address) FORMTEXT       FORMTEXT    FORMTEXT       FORMTEXT      (City)(State)(Zip Code)4.Telephone Number:( FORMTEXT    )  FORMTEXT    - FORMTEXT     Fax Number:( FORMTEXT    )  FORMTEXT    - FORMTEXT     5.Website Address: FORMTEXT      6.E-Mail Address: FORMTEXT      7.LOCATIONS:List (1) all locations within South Carolina and (2) all locations outside the State that are soliciting and/or contracting with debtors located in South Carolina. (Attach additional page(s) as necessary) NOTE: Supplemental Form B must be completed for each location. AddressPhone NumberManager FORMTEXT      ( FORMTEXT    )  FORMTEXT    - FORMTEXT      FORMTEXT       FORMTEXT      ( FORMTEXT    )  FORMTEXT    - FORMTEXT      FORMTEXT       FORMTEXT      ( FORMTEXT    )  FORMTEXT    - FORMTEXT      FORMTEXT      8.Current Business Type and Services Offered:a.  FORMCHECKBOX  Non-Profit  FORMCHECKBOX  For Profit b.  FORMCHECKBOX Sole Proprietorship FORMCHECKBOX Partnership FORMCHECKBOX Limited Liability Company FORMCHECKBOX Corporation(Attach a copy of the agreement, Articles of Incorporation, or Articles of Organization as applicable)c.  FORMCHECKBOX Receiving and distributing consumers funds FORMCHECKBOX Improving consumers credit record, etc. FORMCHECKBOX Negotiating to defer or reduce consumers obligations 9.Name and Address of Registered Agent in South Carolina: FORMTEXT       FORMTEXT       FORMTEXT      (Last)(First)(Middle) FORMTEXT       FORMTEXT       FORMTEXT    FORMTEXT       FORMTEXT      (Street Address)(City)(State)(Zip Code)10.Is this organization owned by a business entity?  FORMCHECKBOX YES FORMCHECKBOX NOIf yes, NAME: FORMTEXT      NOTE: Every owner, partner, member, officer, or director must be listed under Question 11 and must submit the required information, including a Supplemental Form A, unless otherwise stated.11.List all names, titles and percentage owned of every owner, officer, partner, member and director of the applicant. NOTE: Every individual listed below must complete a separate Disclosure Form (Supplemental Form A) UNLESS the person (a) serves as a director on a voluntary board, (b) does not receive compensation directly or indirectly from the corporation, and (c) holds no financial interest in the corporation. NameTitlePercentage of Ownership (If Any)1. FORMTEXT       FORMTEXT       FORMTEXT    2. FORMTEXT       FORMTEXT       FORMTEXT    3. FORMTEXT       FORMTEXT       FORMTEXT    4. FORMTEXT       FORMTEXT       FORMTEXT    5. FORMTEXT       FORMTEXT       FORMTEXT    6. FORMTEXT       FORMTEXT       FORMTEXT    7. FORMTEXT       FORMTEXT       FORMTEXT    8. FORMTEXT       FORMTEXT       FORMTEXT    9. FORMTEXT       FORMTEXT       FORMTEXT    10. FORMTEXT       FORMTEXT       FORMTEXT    12.Briefly describe the business qualifications of the applicant and its owners, partners, members, directors, and officers which qualifies the company to conduct business pursuant to the South Carolina Consumer Credit Counseling Act.  FORMTEXT      (Attach additional page(s) as necessary)YESNO13.Is the applicant currently conducting, or has the applicant previously conducted, its credit counseling business in South Carolina? FORMCHECKBOX  FORMCHECKBOX If yes, give beginning and end dates as applicable:  FORMTEXT      14.Has the applicant or any of its affiliates applied for a license with the South Carolina Department of Consumer Affairs within the last ten (10) years? FORMCHECKBOX  FORMCHECKBOX If yes, attach complete details of the outcome of the application.  YESNO15.Has the applicant or any of its affiliates ever been refused a license to engage in any business or had any license suspended or revoked by any state or federal agency?  FORMCHECKBOX  FORMCHECKBOX If yes, attach complete details of the refusal, suspension, or revocation. 16.Has any state or federal agency ever initiated an administrative or regulatory proceeding or action or entered an order against the applicant or any of its affiliates?  FORMCHECKBOX  FORMCHECKBOX If yes, attach complete details of the event. 17.Does the applicant or any of its affiliates conduct credit counseling in other states? If yes, provide the following information. Also indicate any states in which applications are pending.   FORMCHECKBOX   FORMCHECKBOX StateName of CompanyDate of Initial Registration/ LicensingRegistration/License NumberNumber of Years in Operation FORMTEXT    FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT     FORMTEXT    FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT     FORMTEXT    FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT     FORMTEXT    FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT     FORMTEXT    FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT    18.OTHER ATTACHMENTS: Please use the checklist below to verify your application is complete.Incomplete information could result in delay or denial of your application. FORMCHECKBOX $100 Application/Renewal Fee per location FORMCHECKBOX $50 One-time Investigation Fee FORMCHECKBOX A properly executed Surety Bond issued (a) by a company authorized to transact business in South Carolina, (b) to the South Carolina Department of Consumer Affairs and (c) in the amount of twenty-five thousand dollars ($25,000) or in an amount that equals or exceeds the total amount of south Carolina clients funds in the applicants trust account at the time of application, whichever is greater.  FORMCHECKBOX Financial Statements for the applicant as of the most recent fiscal year. 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(New being a company in business for less than one year.) FORMCHECKBOX A description of the organizations Consumer Education Program. FORMCHECKBOX A copy of the organizations standard Agreement/Contract. FORMCHECKBOX A copy of the organizations Budget Analysis Form, if applicable. FORMCHECKBOX A copy if the organizations Creditor Consent Form, if applicable. FORMCHECKBOX A copy of the organizations Fee Schedule. FORMCHECKBOX Supplemental Form A for every owner, partner, member, officer, and director of the applicant listed in Question #11, unless otherwise stated. FORMCHECKBOX All individuals listed in Question #11 requested Criminal Records Checks, unless otherwise noted. FORMCHECKBOX All individuals listed in Question #11 requested or obtained Personal Current Composite Credit Reports, unless otherwise noted. FORMCHECKBOX Supplemental Form B for every location listed in Question #7. FORMCHECKBOX Counselor applications for persons listed on the organizations Supplemental Form B(s), FORMCHECKBOX A copy of the organizations agreement, Articles of Incorporation, or Articles of Organization, as applicable.  FORMCHECKBOX Evidence of registration with the South Carolina Secretary of State, if a corporation, limited liability company, or limited partnership. (i.e. certified copy of Certificate of Existence or Certificate of Authority to Transact Business in South Carolina). Copies of Articles or Certificates of Existence may be obtained by contacting the South Carolina Secretary of States Office at (803) 734-2158. FORMCHECKBOX A copy of the organizations IRS Exemption Letter, if a non-profit entity. The undersigned swears or affirms and certifies that he/she has completed and/or reviewed all information in this application and that all information contained herein and in all addending and supplemental forms is true and accurate. The undersigned further certifies that giving false information in this application or any addending or supplemental forms constitutes cause for denial or revocation of the application or license and subjects him/her to criminal prosecution for perjury. The undersigned acknowledges the duty and agrees to update and correct this information as it changes. The undersigned warrants that his or her signature below is duly authorized and delivered by and for the entity for which s/he signs SEQ CHAPTER \h \r 1.SWORN TO AND SUBSCRIBED before me this _____ day of _______________, 20 ___ _____________________________________________ Notary Public For: ______________________________ My Commission Expires: _________________________Signature of person completing the form FORMTEXT      Type or Print your name  FORMTEXT      _________________________________________ Type or Print your Business Relationship or Title The South Carolina Freedom of Information Act may require the Department of Consumer Affairs to release this form as a public record; however, personal identifying information will be released only if required by law.  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