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Delaware General AssemblyDelaware RegulationsAdministrative CodeTitle 52100

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5 Del.C. §§2111 and 2112

Effective Date: April 11, 2014


Each licensee shall submit this report to the Office of the State Bank Commissioner twice each year. The first report must be received no later than July 31 and must contain information from January 1 through June 30 of the current year. The second report must be received no later than January 31 and must contain information from January 1 through December 31 of the previous year.

Licensees with more than one licensed office, whose files are maintained at a consolidated, centralized location, may file a consolidated report. Otherwise, a separate report must be submitted for each licensed office.

A completed, signed report may be scanned and submitted by e-mail to not later than July 31 and January 31.

Failure to submit this report when due will be a violation of this regulation. In addition, an examination may be scheduled and examination staff allocated without respect to the licensee’s volume of Delaware loans. This may result in additional examination costs.


1. Name of Licensee: ____________________________________________________


2. Is this a consolidated report? Yes _____ No _____


3. License No.: __________ (If consolidated, list all license numbers): ______________




4. List the address where the loan files are maintained:









5. Examination contact person’s name, title, phone number, fax number and e-mail address:






6. List the Delaware business conducted (number of loans) in each of the following categories:


A. Loans Placed, per agreement: _________________________


Total Dollar Value: $________________________


B. Loans Rescinded: _________________________


C. Applications Denied: _________________________



7. Reporting Period: __________________ to ___________________



I, the undersigned officer, hereby certify that this report is true and correct to the best of my knowledge and belief.


________ _____________________________ ________________________

Date Signature Title


_____________________________ ________________________

Printed Name Phone Number


3 DE Reg. 653 (11/01/99)

17 DE Reg. 994 (04/01/14)



Last Updated: November 07 2014 16:15:11.
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