Form Dbo 260 165 – Fill Out and Use

STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT

CONSENT TO SERVICE OF PROCESS

DBO-260.165 (Rev. 7-13)

TO THE COMMISSIONER OF BUSINESS

OVERSIGHT OF THE STATE OF

CALIFORNIA

CONSENT TO SERVICE OF PROCESS

KNOW ALL MEN BY THESE PRESENTS:

That the undersigned, [

OR

(an individual),

OR

(other entity),]

hereby irrevocably appoints the Commissioner of Business Oversight of the State of California, or the Commissioner's successor in office, to be the undersigned's attorney to receive service of any lawful process in any noncriminal suit, action or proceeding against the undersigned, or the undersigned's successor, executor, or administrator which arises under the Corporate Securities Law of 1968 or any rule or order thereunder after this consent has been filed, with the same force and validity as if served personally on the undersigned.

For the purpose of compliance with the Corporate Securities Law of 1968 of the State of California, notice of the service and a copy of the process should be sent by registered or certified mail to the undersigned at the following address:

(Name and

Address)

[Insert name of corporation, partnership, limited liability company or other entity]

STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT

CONSENT TO SERVICE OF PROCESS

DBO-260.165 (Rev. 7-13) Page 2 of 2

By

Title

OR

[Insert name of individual]

personally appeared

(Here, insert Name and Title of the Officer)

(who proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and

that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature

Any certificate of acknowledgement taken in another place shall be sufficient in the State of California if it is taken in accordance with the laws of the place where the acknowledgment is made.