COMMONWEALTH OF PUERTO RICO

OFFICE OF THE COMMISSIONER OF FINANCIAL INSTITUTIONS

PO BOX 11855
SAN JUAN, PR 00910-3855

APPLICATION FOR A
MONEY TRANSFER BUSINESS LICENSE

INSTRUCTIONS

1. Please answer all questions. Use a separate sheet if the space provided is not
enough. If an item does not apply, state so with N/A.

2. All applicants are advised that this is an official document and that any
misrepresentation or failure to reveal information requested may be deemed to be
sufficient cause for the refusal or revocation of a license.

3. The application shall be filed jointly with the following documents:

- Certified check or money order payable to the Secretary of the Treasury for
$5,000.00 plus $50.00 for each agent.

- Financial Statements of the applicant prepared by a Certified Public

Accountant certifying that applicant has assets of no less than $500,000 of
which at least $100,000 are in liquid assets.

- Declaration of Personal Background of the owner of the business. If

applicant is a corporation, of each of its directors. Include two 2x2
photographs of each of the persons.

- Certification of non-criminal record for the persons mentioned above.

- If the applicant is a Corporation, include a Corporate Resolution authorizing

submission of the application.

- Bond for at least $250,000.

- Applicants employer identification number.

- In case of a nonresident of Puerto Rico, the application shall be

accompanied by a document appointing a resident agent to represent the
nonresident person in any judicial proceeding or to receive any legal notice.

- Certification from the Puerto Rico State Department authoring applicant to

do business in Puerto Rico.

- Description of the structural organization of the company.

4. The applicant must inform this Office of any change in the information provided in

1
 the application and submit supplemental documents.

The forms with all required documents must be mailed to:

OFFICE OF THE COMMISSIONER OF FINANCIAL INSTITUTIONS

LICENSING DIVISION
PO BOX 11855 LICENSE
SAN JUAN, PR 00910-3855

COMMONWEALTH OF PUERTO RICO

OFFICE OF THE COMMISSIONER OF FINANCIAL INSTITUTIONS

LICENSE APPLICATION
LICENSE TYPE: MONEY TRANSFER COMPANY

2
 GeneralInformation

1. Name of Applicant 6. Main Office address

2. Commercial Name(D.B.A.) 7. Mailing Address

3. Organization Type 8. Estimated number of persons to be

employed

4. Place of Incorporation: 9. If applicant is an individual indicate

residential address

5. Telephone Number

10. If applicant is a corporation, please provide the following information for its officers
and Board of Directors.

Name Address Position

11. Name and address of the resident agent.

12. Provide the following information for stockholders who own 10% or more of the
voting stock of the company. If the applicant is a subsidiary, indicate the name of the
holding company and the information corresponding to its stockholders.

Name Address No. of shares and % owned

3
13. If applicant is a partnership indicate the following information for each partner:

Name Address Title

4
 Additional Information

14. Have you or any person mentioned in this application had a license denied,
suspended or revoked in Puerto Rico or any other jurisdiction? If yes, please furnish
details.

15. Have you or any person mentioned in this application had a license, certification or
authorization denied, suspended or revoked by any federal agency? If yes, please furnish
details.

16. Have you or any person mentioned in this application ever been convicted of a
felony? If yes, please furnish details.

17. Describe applicants experience in this or any other type of business. If a corporation
or partnership you may provide a resume for principal officers and directors or partners.

18. Indicate present relationship with other organizations.

19. Provide the following information for senior management including the general
manager or person in charge of the office for which this license is requested.

Name Title Business Address

Informationrelatedtotheofficeorbranchtobeestablished

20. Indicate physical address of the office or branch where business will be conducted.

5
21. Indicate other businesses which will be conducted at applicants premises or at other
locations.

Business Type Location

I,____________________________________ do solemnly swear that the foregoing

answers and statements, together with those in all exhibits attached hereto, have been
knowingly made by me and that the same are true and correct, and that I have not omitted
to state any material fact bearing upon such matters.

Given under my hand this_______ day of _______________ of _________.

_________________________ ___________________________
Authorized Person Signature

Include a Corporate Resolution certified by the secretary of the corporation indicating that
the signer of this application is an authorized officer.

AFFIDAVIT NUMBER___________

Subscribed and sworn before me by________________________________ of legal age and

resident of __________________________________ personally known to me. Given at
__________________________ this ____day of____________of_________.

STAMP
____________________________
Notary Public

If notary is a resident of another State or jurisdiction a certification from such State or

jurisdiction must be included indicating the expiration date of his/her commission.