CALIFORNIA FINANCE LENDERS LAW STATEMENT OF LOAN
Date:
Lender Name:
Lender Address:
Lender's License Number:
Borrower Name(s):
Borrower Address:
1. This loan is made pursuant to the California Finance Lenders Law, Division 9 (commencing with Section 22000)
of the Finance Code. The above-named lender is a licensed finance lender, Department of Corporations
California Finance Lenders License No.
FOR INFORMATION CONTACT THE DEPARTMENT OF
CORPORATIONS, STATE OF CALIFORNIA.
2. The California Finance Lenders Law requires that a licensed finance lender obtain a signed statement from a
borrower as to whether any person has performed any act as a broker in connection with the making of a loan.
Has any person performed any act as a broker in connection with the making of your loan Yes No
If your answer is yes, please indicate below the name of the person who will receive payment for broker service
services and a statement of all sums paid or payable to such person:
3. Loan Information:
A full statement of (i) the actual amount of cash you receive and retain, (ii) any funds paid to third persons
pursuant to your written instructions, and (iii) any fees, charges, costs, insurance premiums or other sums which
have been paid or are to be paid by you or on your behalf at the time the loan is made, is set forth in the HUD-1
or HUD-1A settlement statement delivered to you at settlement.
4. You have the right to make payment in advance in any amount at any time.
By signing below, you acknowledge that you have received and read this disclosure.
Date Date
Date Date
SS15CA (05/10)