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Applications, forms, and reports

Finance

Portable document format (PDF): PDFs need to be printed first, then completed, and mailed to the Division for processing. If you are unable to open one, please download Acrobat Reader from Adobe.

MS Word (Word): If you have MS Word you can fill it in, print it, and mail it to the Division for processing.

Online fillable forms (On-line form): Form that can be filled out online, then submitted to the Division for processing.

Application for authority to organize a state bank 440-2208 last updated: 01/08/2016 PDF​

Confidential biographical and financial report 440-2070 last updated: 01/08/2016 PDF | Word

Designation of registered agent and/or office 440-4009 last updated: 01/08/2016 PDF

Public Records Request 440-4871 last updated: 02/08/2016 PDF

Request for a certificate of name compliance 440-4867 last updated: 04/21/2016 PDF | Word

Special qualifications registration 440-2042 last updated: 01/08/2016 PDF

Trust company application 440-4008 last updated: 01/08/2016 PDF​​​​​​​​​

​TitleForm #FormsRev. Date
Check-cashing annual report440-4803 PDF
Word		01/06/2016
Reporte Anual de Cambio de Cheques440-4803s PDF
Word		01/06/2016
Check-cashing business initial license application​
440-4771 PDF
Word
Español​
PDF​
Word​		02/20/2020
Español​: 11/14/18
Check-cashing business license amendment application (A licensed check cashing business may use this form to make changes to the information on file with the division)440-5470 PDF
Word
02/20/2020
Criminal background and credit check authorization440-4912 PDF
Word		05/25/2016
Public Records Request440-4871 PDF02/08/2016
​​​​​​​​​​​
​TitleForm #FormsRev. Date
Irrevocable Letter of Credit440-4881 PDF
Word		06/28/2010
Public Records Request440-4871 PDF02/08/2016
Request for Waiver - Oregon Collection Agency Registration440-5218 PDF
Word		06/26/2017
Oregon Licensing Notice 440-5434 PDF07/2019
​​
​TitleForm #FormsRev. Date
Consumer Finance Licensee Annual Report440-4818 PDF
Word		05/2017
Criminal background and credit check authorization - Short form 440-5198 PDF
Word		03/16/2017
Public Records Request440-4871 PDF02/08/2016
Oregon Licensing Notice 440-5434 PDF07/2019
​​​

Branch application and checklist 440-2784 last updated: 01/08/2016 PDF | Word

Bylaw amendment 440-2780 last updated: 01/08/2016 PDF | Word

Change of location 440-2779 last updated: 01/08/2016 PDF | Word

Change of registered office and/or agent 440-2781 last updated: 01/08/2016 PDF | Word

Change to list of officials 440-2935 last updated: 01/08/2016 PDF | Word

List of officials 440-2782 last updated: 01/08/2016 PDF | Word

Model bylaws 440-2783 last updated: 03/08/2006 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​

Title Form # Forms Rev. Date
Attestation for Reduced Errors and Omissions Insurance Oregon Debt Buyer License 440-5343​ PDF
Word		 10/2017
Oregon Licensing Notice 440-5434 PDF 07/2019
​
​TitleForm #FormsRev. Date
Public Records Request440-4871 PDF02/08/2016
Oregon Licensing Notice 440-5434 PDF07/2019
​​

Annual report - endowment care cemeteries 440-4016 last updated: 01/08/2016 PDF

Endowment Care for Burial Vaults and Markers Penal Bond with Surety 440-3375 last updated: 01/08/2016 PDF | Word

Endowment Care for Crypts or Niches Penal Bond with Surety 440-3374 last updated: 01/08/2016 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​

Funeral and Cemetery Consumer Protection Trust Fund Annual Report 440-4013 last updated: 01/08/2016 PDF | Word

Funeral and Cemetery Consumer Protection Trust Fund Claim for Restitution 440-4018 last updated: 01/08/2016 PDF | Word​ ​​​​​

Irreducible fund cemetery annual report 440-2929 last updated: 06/16/2017 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​

​​​​​​​​​
Title Form # Forms Rev. Date
Irrevocable Letter of Credit 440-3485 PDF
Word		 01/11/2016
Limited Manufactured Structures Dealer License Application 440-2965 PDF
Word		 10/23/2019
Manufactured Structures Dealer and Limited Manufactured Structures Dealer License Correction Application 440-2964 PDF
Word		 10/23/2019
Manufactured Structures Dealer and Limited Manufactured Structures Dealer Surety Bond 440-2966 PDF
Word		 05/09/2017
Manufactured StructuresDealer License Application 440-2962 PDF
Word		 10/23/2019
Manufactured Structures Dealer Supplemental License Application 440-2963 PDF
Word		 10/23/2019
Manufactured Structures License Report of Examination 440-3498 PDF
Word		 01/11/2016
Public Records Request 440-4871 PDF
Word		 02/08/2016
Manufactured Structures Dealer License Renewal Application 440-5454 PDF
Word		 02/08/2016
Limited Manufactured Structures Dealer License Renewal Application 440-5455 PDF
Word		 10/23/2019
​​

Criminal background and credit check authorization 440-4912 last updated 5/25/2016 PDF | Word​

Master Trustee 2% Per Year Reporting Form 440-4957 last updated: 01/11/2016 PDF | Word

Master trustee annual report and registration renewal 440-4017 last updated: 01/11/2016 PDF | Word

Master trustee election to pay administrative fees & expenses from trust fund deposits 440-4955 last updated: 01/11/2016 PDF | Word

Master trustees registration application 440-4012 last updated: 01/11/2016 PDF | Word

Notice of appointment of successor depository or master trustee 440-3437 last updated: 01/11/2016 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​​​​​

Deposit in lieu of security device 440-4603 last updated: 01/11/2016 PDF

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​​​​

​
Title Form # Forms Rev. Date
Affidavit and undertaking - no clients’ trust account 440-2776 PDF
Word		 05/12/2017
Annual Recertification of Bona Fide Nonprofit Organization 440-4990 PDF 09/11/2019
Balance sheet and income statement 440-5370 PDF
Word		 04/11/2018
Checklist for Determination of Qualification for Bona Fide Nonprofit Organization Status 440-4935 PDF
Word		 01/06/2016
Clients’ trust account, notice of 440-2777 PDF
Word		 01/06/2016
Examination - loan worksheet 440-3369 PDF
Word		 01/06/2016
Examination report 440-3368 PDF
Word		 02/03/2016
Foreclosure Notice Form 440-4795 PDF
Word		 07/03/2013
Interest Rate Lock/Float Agreement 440-4828 PDF
Word		 11/16/2015
Investor Disclosure Information 440-4827 PDF
Word		 08/20/2008
Mortgage Servicer Irrevocable Letter of Credit 440-5227 PDF
Word		 08/2017
Oregon Licensing Notice 440-5434 PDF 07/2019
Personnel Information Ledger 440-4826 PDF
Word		 01/07/2010
Public Records Request 440-4871 PDF 02/08/2016
​​​​​​​​​​​​​​​​​​​

Annual report form 440-3371 last updated: 12/13/2019 PDF | Word

Application package 440-3232 last updated: 12/13/2019 PDF | Word

Application amendment 440-5463 last updated: 12/13/2019 PDF | Word

Criminal background and credit check authorization 440-4912 last updated: 05/25/2016 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​​​​​​​​​

Title Form # Forms Rev. Date
Criminal background and credit check authorization - Long form 440-4912 PDF
Word		 03/16/2017
Criminal background and credit check authorization - Short form 440-5198 PDF
Word		 03/16/2017
Payday / Title Licensee Annual Report 440-4817 PDF
Word		 05/2017
Public Records Request 440-4871 PDF 02/08/2016
Oregon Licensing Notice 440-5434 PDF 07/2019
​

Certified provider annual report and certification renewal 440-4014 (last updated: 02/17/2017) PDF | Word

Certified provider application 440-4011 (last updated: 01/11/2016) PDF | Word

Endowment Care for Burial Vaults and Markers Penal Bond with Surety 440-3375 (last updated: 01/08/2016) PDF | Word

Endowment Care for Crypts or Niches Penal Bond with Surety 440-3374 (last updated: 01/08/2016) PDF | Word​

Funeral and Cemetery Consumer Protection Trust Fund Annual Report 440-4013 (last updated: 06/26/2017) PDF | Word

Funeral and Cemetery Consumer Protection Trust Fund Claim for Restitution 440-4018 (last updated: 01/08/2016) PDF | Word​

Notice of appointment of successor depository or master trustee 440-3437 (last updated: 01/11/2016) PDF | Word

Public Records Request 440-4871 (last updated: 02/08/2016) PDF​​​​​

​​​​​​

Securities

Note: The forms listed below are specific to Oregon. For additional required forms, please visit the NASAA or SEC websites.

​​​TitleForm #FormsRev. Date
​Balance sheet and income statement440-5370 PDF
Word		10/2019
Dual undertaking440-2131 PDF04/18/2017
Non-FINRA Broker-Dealer Renewal Application440-2785 PDF10/26/2020​
Oregon Broker-Dealer Affidavit440-4861 PDF
Word		01/11/2016
Public Records Request440-4871 PDF02/08/2016
Registration for Resale, or Dealing and Trading440-2203 PDF
Word		01/11/2016
Trade/assumed name440-2774 PDF
Word​​​​​​​​​		01/11/2016
​​​​​​​​​​​ ​
​​TitleForm #FormsRev. Date
​​Annual financial statement reporting Excel

 

Attestation of Errors and Omissions Insurance440-5379PDF
Word		06/21/2018
Balance sheet and income statement440-5370PDF
Word		10/2019
Dual undertaking440-2131PDF04/18/2017
Firm renewal440-2306PDF01/11/2016
Public Records Request440-4871PDF02/08/2016
Representative/salesperson renewal440-2118aPDF10/26/2020
Representative/salesperson termination440-2118bPDF
Word		01/11/2016
Surety bond440-2014PDF01/11/2016
Trade/assumed name440-2774PDF
Word​​​​​​​​​​​		01/11/2016
​​​​​​​​​​​
​
​​TitleForm #FormsRev. Date
Certain Compensatory Benefit Plans440-5180PDF
Word		02/07/2017
Oregon form440-2013PDF
Word

01/11/2016
Oregon Intrastate Offering Exemption440-5001PDF
Word		01/11/2016
Oregon Interstate Offering Final Sales Report440-5353PDF
Word		12/2017
Proceeds Escrow Agreement440-3517PDF01/11/2016
Registration for Resale, or Dealing and Trading440-2203PDF
Word		01/11/2016
Representative/salesperson renewal440-2118a PDF10/26/2020
Representative/salesperson termination440-2118bPDF
Word		01/11/2016
Solicitation of Interest440-3008PDF
Word		01/11/2016
Stock Escrow Agreement440-3438PDF01/11/2016
​​​​​​​​​​​ ​

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