Forms by Division

Consumer Credit | Financial Institutions
Securities and Business Investments

The following Department of Banking application forms may be downloaded for submission to the agency. Please contact the appropriate division for information on licensing procedures and requirements.

Consumer Credit Division

Check Cashers | Collection Agencies | Debt Adjusters | Debt Negotiation
Mortgage Licensing | Money Services Businesses
Sales Finance Companies | Small Loan Companies

Note: where indicated the following forms must be printed on legal size paper or required information may be lost.

Check Cashing Service License Application

Essential Statutes
Please reference the relevant Connecticut Statutes and Regulations before applying for a license.

• Checklist - Main Office (4 pages, 302 KB)      
• Checklist - Branch Office (2 pages, 294 KB)
• Application - Main Office (6 pages, 296 KB)
• Application - Branch Office (2 pages, 284 KB)   
• Personal and Business History Statement (2 pages, legal size, 288 KB)
• Additional Check Cashing Service forms

Essential Statutes
Please reference the relevant Connecticut Statutes and Regulations before applying for a license.

• Checklist - Main Office  (3 pages, 286 KB)
• Checklist - Branch Office (2 pages, 281KB)
• Application - Main Office (7 pages, 293 KB)
• Application - Branch Office (3 pages, 281 KB)
• Bond (1 page, 76 KB)
• Personal and Business History Statement (2 pages, legal size, 284 KB) 
• Attestation Form to be attached to required financial statement (1 page, 281 KB)
• Additional Consumer Collection Agency forms

Essential Statutes
Please reference the relevant Connecticut Statutes and Regulations before applying for a license.  Additionally, please reference Sections 23-26, inclusive, and Section 28 of Public Act 09-208 and Public Act 09-23, before applying for a license.

• Checklist - Main Office (3 pages, 285 KB)
• Checklist - Branch Office (2 pages, 281 KB)
• Application - Main Office (5 pages, legal size, 292 KB)
• Application - Branch Office (2 pages, legal size, 280 KB)
• Attestation Form - to be attached to required financial statement (1 page, 56 KB)
• Debt Adjuster Bond (1 page, legal size, 17 KB)
• Personal and Business History Statement (2 pages, legal size, 284 KB)
• List of Employees (2 pages, 19 KB)
• Additional Debt Adjuster forms

Please reference Sections 20 to 33, inclusive, of Public Act 09-208 and Section 41 of Public Act 09-209, before applying for a license.

• Checklist - Main Office (3 pages, 285 KB)
• Checklist - Branch Office (2 pages, 281 KB)
• Application - Main Office (5 pages, legal size, 293 KB)
• Application - Branch Office (2 pages, legal size, 281 KB)
• Attestation Form to be attached to required financial statement (1 page, 275 KB)
• Debt Negotiation Bond (1 page, legal size, 17 KB)
• Personal and Business History Statement (2 pages, legal size, 285 KB)
• List of Employees (2 pages, 19 KB)

Essential Statutes
Please reference the relevant Connecticut Statutes and Regulations and Public Act 09-208 before applying for a license.

• Checklist (4 pages, 295 KB)
• Application (7 pages, 297 KB)
• Personal and Business History Statement (2 pages, legal size, 288 KB)
• Licensee Bond and Surety Bond Calculation form (2 pages, legal size, 78 KB)
• Authorization to Disclose Deposit Information (1 page, 10 KB)
• Agent List (2 pages, 77 KB)
• Additional Payment Instruments/Money Transmitter forms

Essential Statutes
Please reference the relevant Connecticut Statutes and Regulations before applying for a license.

• Checklist - Main Office (3 pages, 283 KB)
• Checklist - Branch Office (2 pages, 285 KB)
• Application - Main Office (7 pages, 293 KB)
• Application - Branch Office (3 pages, 281 KB)
• Additional Sales Finance Company forms

Essential Statutes
Please reference the relevant Connecticut Statutes and Regulations before applying for a license.  Additionally, please reference Public Act 09-208 and Public Act 09-209, before applying for a license.

• Checklist - Main Office (3 pages, 284 KB)
• Checklist - Branch Office (2 pages, 280 KB)
• Application - Main Office (7 pages, 293 KB)
• Application - Branch Office (3 pages, 280 KB) 
• Application to Conduct the Small Loan Business on the Same Premises as Certain Other Businesses (2 pages, legal size, 56 KB)
• Personal and Business History Statement (2 pages, legal size, 285 KB)
• Attestation Form to be attached to required financial statement (1 page, 271 KB)
• Additional Small Loan Company forms

Financial Institutions Division 

Banks | BIDCOs | Credit Unions | Foreign Banks

Banks

• Application To Acquire, Alter or Improve Bank Real Estate
  (1 page; file size 31 KB; revised to September, 2004)

• Application To Establish a Branch, Limited Branch, Interstate Branch or to Relocate a Branch or Limited Branch
    (4 pages, file size 36 KB)
  Connecticut Addendum to Uniform Interstate Application/Notice
    (2 pages, file size 48 KB, revised to July 2006)

Applications for branches, limited branches, interstate branches or to relocate branches should be made with the uniform application posted above, along with the Connecticut addendum. Please contact Mary Ellen O'Neill, Division Director, at mary.oneill@ct.gov or by phone at (860) 240-8185, for additional information concerning the application process.

• Interagency Charter and FDIC Insurance Application
  (43 pages, file size 95KB)
     Addendum for Department of Banking
     (Word 97 file, 10 pages, size 44 KB)
     Interagency Biographical and Financial Report Form
     (Word 97-2002 file, 18 pages, size 415 KB)

• Application for Conversion of a Mutual Connecticut Bank to a Capital Stock Connecticut Bank
  (8 pages, 71 KB)

• Bank Director's Oath
  (Form available in either Word 2002 format 26 KB or PDF format 14 KB, identical content, both 1 page)

• Main Office Relocation Application
  (5 pages, file size 56 KB)

• Application to Establish A Mobile Branch and Supplemental Schedule
  (6 pages, file size 118 KB)

Business and Industrial Development Corporations

• Initial application  
  (3 pages, file size 113 KB)
• Renewal application  
  (2 pages, file size 109 KB)

Credit Union Forms

• Credit Union Officials Report (Form CU 50)
  (2 pages; file size 52 KB)

Foreign Banks

• Application By A Foreign Bank For A License For A Representative Office
  (24 pages; file size 150 KB. Note: some pages print landscape)

• Application By A Foreign Bank For A License For A State Branch Or State Agency
  (35 pages; file size 94 KB)
  

Securities and Business Investments Division

Business Opportunities | Licensing | Securities Registration | FINRA forms

Business Opportunities:

• Application To Register Business Opportunity Investment
  (Form CT BOIA-1 and Form CT BOIA-2)
  (9 pages; file size 320 KB)

• Post-Sale Forms - Business Opportunities
  (6 pages; file size 28 B)
  Note: Acceptance of a post-sale registration is subject to the discretion of the Commissioner.

Licensing:

• Agent of Issuer Registration Instructions

• Form BR (Uniform Branch Office Registration Form)
  (12 pages, file size 439 KB)

• Broker-Dealer Registration Instructions

• Form U-4, Uniform Application for Securities Industry Registration or Transfer
  (57 pages, file size 484 KB)

• Form U-5, Uniform Termination Notice for Securities Industry Registration
  (34 pages, file size 589 KB)

• Form BD, Uniform Application for Broker-dealer Registration
  (36 pages, file size 488 KB)

• Form BDW, Uniform Request for Broker-dealer Withdrawal
  (3 pages, file size 44 KB)

• Investment Adviser Registration Instructions

• Connecticut Supplement for State-Regulated Investment Advisers
  (3 pages, file size 312 KB)
   
• Uniform Application for Investment Adviser Registration (Form ADV)
  (93 pages, file size 893 KB)
   
• Uniform Application for Investment Adviser Registration (Form ADV part II)
  PDF Fillable Only (14 pages, file size 568 KB)
   
• Investment Advisory Registrant's Certificate (state registered advisers)
  (1 page, file size 55 KB)
   
• Form ADV-E
  Certificate of Accounting of Client Securities and Funds in Possession or Custody of an Investment Adviser
  (1 page, file size 28 KB)
   
• Notice of Withdrawal from Registration As Investment Adviser (Form ADV-W)
  (9 pages; file size 40 KB)

• Trade Or Assumed Name Notification (Form DBA-1) 
  (2 pages; file size 50 KB)

Securities Registration:

• Model Accredited Investor Exemption - Uniform Notice of Transaction
  (3 pages, file size 144 KB)

• Consent To Service Of Process
  Form U-2 Uniform Consent to Service of Process
  (4 pages, file size 104KB)

• Form D  (9 pages; file size 936 KB)

• Form NF
  (4 pages; file size 156 KB)

• New England Regional Review application form
  (1 page; file size 19 KB)

• Post-Sale Forms - Securities
  (6 pages; file size 22 KB)
  Note: acceptance of a post-sale registration is subject to the discretion of the Commissioner.

• Application To Register Securities (Form U-1 or CT-3)
  (4 pages; file size 42 KB)
   
• Sales Agent/Broker-Dealer Questionnaire for Connecticut
  (1 page, file size 56 KB) Revised June, 2003
   
• Small Company Offering Registration (SCOR) Form U-7
  (38 pages, file size 171 KB, Word document)
  
  • Small Company Offering Registration (SCOR) Manual
    (108 pages, file size 411 KB, Word document)
     
• Uniform Form Of Corporate Resolution (Form U-2A)
  (1 page; file size 11 KB)

  External Links:

To Top