Thankyoufortakingtime tosubmitaconsumercomplainttotheDepartmentofBusiness Oversight.By informing usofpotentiallyimproper orillegal activityinthefinancial services marketplace,yourinput helps us protectyouandother Californians.
1. Your Information (typeorprintclearly):
(We collectthe following informationsothatwe cancontactyoufor followup information andtodeterminewho else may beaffectedby the issue raisedinyour complaint.)
Full Name (First, MI, Last)
Address (Street, City, State and Zip Code)
Daytime Phone NumberE-Mail Address
What is the best way to contact you? Phone MailEmail
Your Age (optional):Under 30 30-5050 and Over
Are you currently in the United States Military? Yes (Branch:) No
2. Information on theindividualororganization aboutwhich you have acomplaint:
Full Nameof Financial Institution,Business,Company,Firm,orPerson
Business Address (Include Room #, Suite #, or Apt. #), City, State, Zip Code
Business PhoneFull Name of Salesperson, Agent or Other Representative (if applicable)
3. Have youcontacted the financialinstitution,business,firm orindividual(s)regardingyourcomplaint?
Yes No Ifyes,include names,dates andresultsofyour contact(s)in#4 below. Attachcopies ofall relateddocuments.
4. Describe your complaint. Pleaseclearlydescribe the eventsinthe orderinwhichthey occurred. Includefullnames, addresses,adescription oftheproblemwiththeamount(s),date(s) ofanytransaction(s)andthecontactinformation of anywitnessestothetransactions,andany otherrelevantinformationthatmayassistusinresolvingyourcomplaint. Finally,pleasestateifyou havefiledalawsuit orarbitrationforthiscomplaint.Foryourprotection, DONOTINCLUDE PERSONALCONFIDENTIALINFORMATION SUCH AS YOURSOCIAL SECURITYNUMBER.Include extra pagesasnecessary.
5. Whatdo you believewould be a fair resolution tothismatter?
Insubmittingthiscomplaint,youagreetheinformation providedistrueandcorrecttothebestofyourknowledgeandthatthe information maybeusedbytheDepartment foritsinvestigation. Consumercomplaintsareconsideredtohavebeenreceived by theDepartmentinconfidence.However,the Departmentmay,at itssolediscretion,discloseyourcomplainttothepersonorentity forthepurpose ofcorrectiveaction. TheDepartment mayalsochoosetodiscloseyourcomplainttoothersforthepurposeof facilitating an investigation of the person or entity complained against or initiating legal proceedings against the same under
the Department’s investigation.
Mailtheform anda copy ofalldocumentationto: DepartmentofBusinessOversight
Attn:ConsumerServices Office
1515KStreet,Suite 200
Sacramento,CA 95814
TheDepartmentofBusinessOversightwill contact youshortly after receiptofthis form.If youhave questionsor need assistancefilling outthis form,pleasecall the Departmentof BusinessOversight’sConsumer ServicesOfficetoll-freeat
866-275-2677
HowWe Can Help You:
IfyoubelievealicenseeoftheDepartment ofBusinessOversighthasactedimproperly, or a company or person is conducting unlicensed activity that is withinthe Department’s jurisdiction, please submit a complaint form.
ComplaintssubmittedtotheDepartmentarereviewed todeterminewhetheraninvestigation and possibleenforcement action maybewarranted. Pleasedonot,however,consideracomplainttothe Departmentasasubstituteforpursuing privatelegalremedies.The Departmentisunabletogiveyoulegaladvicesopleaseconsulta privateattorneyifmoney needstobe recoveredora contractneedstobe cancelled. TheDepartmentdoesnothavethestatutoryauthorityto awarddamages,overturnfinesorothercharges. TheDepartmentisunabletobecomeinvolvedincomplaintsthatare in litigationor havebeen litigated.
TheDepartment values yourprivacy. Complaints filedwiththeDepartmentaregenerallyconfidential,however dependingonthenature ofthecomplaint,particularlyagainstlicensedfinancialinstitutionsand other lenders,the Departmentmaysharecertaininformationtoresolvethematter. Complaintsregardingunlicensedactivityarekept confidential. Westronglyencourageany memberof thepublictofileacomplaintiftheybelievealicenseehasengaged in wrongful activity. Ifyourprivacyisof concern,pleasenotethatin the description ofyour complaint.
IfawrittencomplaintissubmittedtotheDepartmentthatisnotwithinourjurisdiction,wewillreferthecomplaintto theappropriateagencyandprovideyouacopy of thereferralsoyourissue maybedealtwithbytheappropriate regulatoryagency.
Before You Submita Complaint,Here’s WhatWe Need:
•CompletedComplaintForm.Pleasetypeor printclearlyin ink.
• Copiesof alldocumentation. Pleasedo notsendoriginals.
Aboutthe DepartmentofBusinessOversight:
TheDepartment of BusinessOversight(DBO)providesprotection toconsumersand servicestobusinessesengaged in financialtransactions.The Departmentregulatesavarietyoffinancialservices,products,transactionsand professionals, including:
•State-Chartered Banks
•Bill payers,checksellers,and proraters(consumer creditcounselors,debtmanagementcompanies)
•Businessand IndustrialDevelopmentCorporations
•State-Chartered CreditUnions
•IndependentEscrowcompaniesand agents.
•Premium FinanceCompanies
•Securitiesprofessionals(broker-dealers, investmentadvisers,financial planners)
•TrustCompaniesandDepartments
•Financelenders,mortgageloan servicers,and certainmortgagelendersand mortgagebrokers
•Foreign (OtherStateand OtherNation)Banks
•State-Chartered IndustrialBanks
•LocalAgency SecurityProgram(LASP)
•MoneyTransmitters
•Offer and SaleofSecurities
•Offer and SaleofFranchises
•Paydaylenders
Formore information about licenseesofDBO,please visit .
STATE OFCALIFORNIA -DEPARTMENT OF BUSINESS OVERSIGHT
CONSUMER COMPLAINT FORM
DBO 801 (Rev. 10-13) Page 1 of 3
NOTICEREQUIREDUNDER STATELAW
Thefollowing noticeisrequired bystatelawundertheInformationPracticesActof1977(California Civil CodeSection
1798.17).
TheCalifornia DepartmentofBusinessOversightrequeststheinformation intheattached formtodeterminewhether:
•A license,qualification,registration,certificateorother authorityshould beaccepted,granted,approved, denied,revoked,or limited in anyway;
•Business entitiesor individuals licensedorotherwiseregulated bytheDepartment of BusinessOversightare conducting themselvesin accordancewith applicablelaws;and/or
•Lawsadministered bytheDepartment ofBusiness Oversightare being orhavebeen violated and whether administrativeaction,civilaction,or referral toa self-regulatoryorganizationorother governmentagencyis appropriate.
All informationyou provideis voluntary.Failure to provide all orany partof theinformation requested mayhinder the
Departmentof BusinessOversightfrominvestigatingyourcomplaint.
Wemayshare your personal information,asneeded,with licensed businessentitiesor individualstofacilitateresolution of yourcomplaint.Wemayalsoshare your information withothergovernmentagenciesor self-regulatory
organizations.
TheCommissioneris responsiblefortheperformanceof allduties,theexerciseofall powersand jurisdiction,and the assumption and dischargeof all responsibilitiesvested bylawin the Department. TheCommissionerhasand may exerciseallthepowersnecessaryorconvenientfor theadministration and enforcementof,among other laws,thelaws described in Financial Code Section 300.TheCommissionermayissuesuch rulesand regulationsconsistentwith lawas he orshemay deemnecessaryor advisableinexecuting thepowers,duties, andresponsibilities ofthe Department.
Theinformationyou provideismaintained bytheDepartmentof BusinessOversightpursuanttooneormore ofthe following laws:
- CorporateSecurities Law of 1968(CorporationsCode Section25000,etseq.);
- Capital AccessCompanyLaw(CorporationsCodeSection 28000,etseq.);
- BucketShop Law(CorporationsCodeSection 29000, etseq.);
- California CommodityLawof 1990(CorporationsCodeSection29500,etseq.);
- FranchiseInvestmentLaw(CorporationsCodeSection31000,etseq.);
- Financial InstitutionsLaw(Financial CodeSection 99,etseq.);
- MoneyTransmission Act(Financial Code Section2000,etseq.);
- CheckSellers,BillPayersand ProratersLaw(FinancialCodeSection 12000,etseq.);
- California CreditUnion Law(Financial CodeSection14000,etseq.);
- CaliforniaDeferredDepositTransactionLaw(FinancialCodeSection 23000,etseq.);
- EscrowLaw(Financial Code Section 17000,etseq.);
- California FinanceLendersLaw(FinancialCodeSection 22000,etseq.);
- SecuritiesDepositoryLaw(Financial CodeSection 30000,etseq.);and
- California Residential Mortgage Lending Act(FinancialCode Section50000,etseq.).
You havearighttoseeyour personalinformation. The official responsibleformaintaining information gathered bythe
Department ofBusiness Oversightis:
DeputyCommissioner,Officeof Managementand Budget
Department ofBusiness Oversight
1515KStreet, Suite200
Sacramento,California 95814-4052 (916)445-5541