Indiana Code
Chapter 4. License Issuance and Renewal
23-2.5-4-3. Mortgage Loan Originator License Application Requirements

Sec. 3. (a) An application for issuance or renewal of a mortgage loan originator license must be made on a form prescribed by the commissioner.
(b) An application under subsection (a) must include the following information for the individual who seeks to be licensed as a mortgage loan originator:
(1) The name of the individual.
(2) The home address of the individual.
(3) The home telephone number of the individual.
(4) The individual's Social Security number and date of birth.
(5) The name of the:
(A) loan broker; or
(B) applicant for a loan broker license;
for whom the individual will act as a mortgage loan originator.
(6) Consent to service of process under section 9 of this chapter.
(7) Evidence that the individual has completed the education requirements described in IC 23-2.5-6.
(8) An affidavit completed in the manner prescribed by the commissioner stating the address of each location where the individual intends to habitually or repeatedly conduct mortgage loan origination activities.
(9) An application fee of fifty dollars ($50).
(10) All:
(A) registration numbers previously issued to the individual under IC 23-2-5, if the applicant was registered as an originator or a principal manager under IC 23-2-5 before its repeal on July 1, 2019; and
(B) license numbers previously issued to the individual under IC 23-2-5 (before its repeal) or this article.
(11) An indication as to whether the mortgage loan originator is the branch manager of a loan broker office and the address of the loan broker office.
(12) Written authorization for the commissioner or an agent of the commissioner to obtain a consumer report (as defined in IC 24-5-24-2) concerning the individual.
As added by P.L.175-2019, SEC.2.