Sample Filing Forms
Please read the appropriate booklets before using these sample documents. Note: A Guide to the National Banking System and A Guide to Tribal Ownership of a National Bank are not listed because they do not contain downloadable samples. This collection of information has been approved by the Office of Management and Budget (OMB) under control number 1557-0014 (expires November 30, 2013). Under the Paperwork Reduction Act, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
Application Documents| General Policies and Procedures |
|---|
| Change In Assets Applications | Word or PDF | | Significant Deviation Policy | Word or PDF |
| Background Investigations |
|---|
| Consent Form for DEA Background Investigations | Word or PDF | | Interagency Biographical and Financial Report | Word or PDF | | Corporate Background and Financial Report | Word or PDF | | Appointment of Agent | Word or PDF | | IRS Tax Check Waiver | Word or PDF |
| Charters |
|---|
| Charter Application | Word or PDF | | Business Plan | Word or PDF | | Financial Projections | Word or PDF | | Application Amendments | Word or PDF | | Public Notice Sample | Word or PDF | | Minority-Owned National Banks Policy Statement | PDF | | First Meeting of Organizers | Word or PDF | | Articles of Association | Word or PDF | | Instructions - Articles of Association | Word or PDF | | Organization Certificate | Word or PDF | | Contact Person | Word or PDF | | Waiver of Notice of Organizing Board's First Meeting | Word or PDF | | Organizing Board's First Meeting | Word or PDF | | Individual Oath of Bank Director | Word or PDF | | Joint Oath of Bank Directors | Word or PDF | | Oaths of Bank Directors Instructions | Word or PDF | | Bylaws | Word or PDF | | Subscription | Word or PDF | | Capital Stock Payment Certificate | Word or PDF | | Corporate Resolution | Word or PDF | | Proxy Card | Word or PDF | | Notice of First Shareholders' Meeting | Word or PDF | | Minutes of the First Shareholders' Meeting | Word or PDF | | Minutes of Subsequent Organizing Board Meetings | Word or PDF | | Waiver of Notice of the First Board Meeting | Word or PDF | | First Meeting of Directors | Word or PDF | | Organization Completed | Word or PDF | | Preopening Checklist for Organizers | Word or PDF |
| Conversions |
|---|
| Conversion Application | Word or PDF | | Authority for Conversion to National Bank | Word or PDF | | Letter Certifying Conversion Completion | Word or PDF | | Oaths of Bank Directors | Word or PDF | | Instructions - Organization Certificate | Word or PDF | | Organization Certificate | Word or PDF | | Articles of Association | Word or PDF | | Bylaws | Word or PDF |
| Branches and Relocations |
|---|
| Branch and Relocation Application | Word or PDF | | Main Office Relocation to Existing Branch Site within the Same City, Town or Village | Word or PDF | | Opening Date of Branch Office | Word or PDF | | Opening Date for Relocation of Main Office to Branch Site within the Same City, Town, or Village | Word or PDF |
| Business Combinations |
|---|
| Business Combination Application - Checklist and Community Reinvestment Commitments | Word or PDF | | Business Combination Application-Streamlined | Word or PDF | | Interagency Bank Merger Act Application | Word or PDF | | Branches Requiring Authorization | Word or PDF | | Bank Merger Screen | Word or PDF | | Merger With Nonbank Subsidiary or Affiliate | Word or PDF | | Application: Interim National Bank Charter | Word or PDF | | Application: Reorganization - Subsidiary of a BHC | Word or PDF | | Stock Payment Certificate and Oaths of Directors and Officers | Word or PDF | | Shareholders' Waiver of Notice of Shareholders' Meeting and Written Consent of Business Combination | Word or PDF | | Board of Directors' Waiver of Notice of Board Meeting and Written Consent of Business Combination | Word or PDF | | Emergency Processing Request | Word or PDF | | Notice of Consummation | Word or PDF | | Notice of Shareholders' Meeting to Vote on Combination | Word or PDF | | Public Notice and Instructions | Word or PDF | | Secretary's Certificate of Board of Directors' Approval of Combination | Word or PDF | | Secretary's Certificate of Shareholders' Approval of Combination | Word or PDF | | Sample Agreements - Consolidation | Word or PDF | | Sample Agreements - Merger | Word or PDF | | Sample Agreement - Purchase and Assumption | Word or PDF |
| Fiduciary Powers |
|---|
| Application | Word or PDF | | After-the-Fact Notice | Word or PDF | | Surrender of Fiduciary Powers | Word or PDF | | Fiduciary Operating Plan-Instructions | Word or PDF | | Commencement of Fiduciary Activities Notice | Word or PDF |
| Investment in Subsidiaries and Equities |
|---|
| After-the-Fact Notice-Subsidiary | Word or PDF | | After-the-Fact Notice- Bank Service Company | Word or PDF | | After-the-Fact Notice-Equity Investment | Word or PDF | | Annual Report on Operating Subsidiaries | Word or PDF | | Annual Report on Operating Subsidiaries Guidelines | Word or PDF | | Operating Subsidiary Application | Word or PDF | | Bank Service Company Application | Word or PDF | | Financial Subsidiary Notice | Word or PDF | | Financial Subsidiary Certification | Word or PDF | | Financial Subsidiary Notice and Certification | Word or PDF |
| Branch Closings |
|---|
| Advance Branch Closing and Downgrade Notice | Word or PDF | | Final Branch Closing, Consolidation, Relocation, or Downgrade Notice | Word or PDF | | Sample Customer Notice of Branch Closing | Word or PDF |
| Capital and Dividends |
|---|
| Application: Increase in Capital for Other Than Cash | Word or PDF | | Application: Increase in Capital for Material Noncash Contribution | Word or PDF | | Application: Reduction of Permanent Capital | Word or PDF | | Application: Quasi-Reorganization | Word or PDF | | Application: Dividend-In-Kind | Word or PDF | | Application: Dividend Exceeding 12 USC 60 Limits | Word or PDF | | Application: Reverse Stock Split | Word or PDF | | Notice: Increase in Stock for Cash | Word or PDF | | Notice: Preferred Stock Terms | Word or PDF | | Notice: Increase in Stock for Property | Word or PDF | | Notice: Noncash Contribution to Surplus | Word or PDF | | Notice: Par Value Change | Word or PDF | | Notice: Conversion of Preferred Stock | Word or PDF | | Notice: Reduction of Permanent Capital | Word or PDF | | Notice: Stock Dividend | Word or PDF | | Pro Forma Balance Sheet | Word or PDF | | Projected Regulatory Capital Schedule | Word or PDF |
| Change in Bank Control |
|---|
| Affidavit | Word or PDF | | Interagency Notice of Change in Control | Word or PDF | | Publication Notice | Word or PDF |
| Changes in Directors and Senior Executive Officers |
|---|
| Interagency Notice of Change in Director or Senior Executive Officer | Word or PDF |
| Changes in Corporate Title and Address |
|---|
| Notification of Change of Corporate Title | Word or PDF | | Change of Address | Word or PDF |
| Director Waivers |
|---|
| Request for Citizenship Waiver | Word or PDF | | Request for Residency Waiver | Word or PDF |
| Investment in Bank Premises |
|---|
| After-the-Fact Notice | Word or PDF | | Application for Increase | Word or PDF |
| Management Interlocks |
|---|
| Exemption - Diversified Savings and Loan Holding Company | Word or PDF | | General Exemption - No Presumption | Word or PDF | | General Exemption - Presumption Applicable | Word or PDF |
| Subordinated Debt |
|---|
| Application to Issue Subordinated Debt | Word or PDF | | Application to Prepay Subordinated Debt | Word or PDF | | Notice of Debt Issuance | Word or PDF |
| Termination of National Bank Status |
|---|
| Public Notice of Voluntary Liquidation | Word or PDF | | Shareholders' Resolution | Word or PDF | | Report of Condition at Commencement of Liquidation | Word or PDF | | Report of Progress of Liquidation | Word or PDF | | Expedited Liquidation Final Notice | Word or PDF | | Expedited Liquidation Preliminary Notice | Word or PDF | | Conversion Notice | Word or PDF | | Merger or Consolidation Notice | Word or PDF | | Voluntary Liquidation Notice | Word or PDF | | Voluntary Liquidation Preliminary Notice | Word or PDF |
| Federal Branches and Agencies |
|---|
| Initial and Additional Establishments |
|---|
| Application to Establish an Initial/Additional Federal Branch or Agency w/ Instructions | PDF | | Initial and Additional Establishments - Sample Public Notice | Word or PDF | | Financial Data | Word or PDF | | Cover Letter for Initial/Additional Establishment Application | PDF | | Acquisitions |
|---|
| Request for After-the-Fact Approval | PDF | | Application to Acquire a Federal Branch or Agency | PDF | | Acquisitions - Sample Public Notice | Word or PDF | | Acquisitions Cover Letter | Word or PDF | | Conversion or Contraction of Operations |
|---|
| Application for a Change of Status of an Office of a Foreign Bank | PDF | | Application Cover Letter (State-to-Federal License) | Word or PDF | | Application Cover Letter (Federal Agency or Limited Federal Branch Conversion) | Word or PDF | | Notice of Contraction of Activities | Word or PDF | | Relocations |
|---|
| Federal Branch and Agency Relocation Application | Word or PDF | | Relocations - Sample Public Notice | Word or PDF | | Cover Letter for Relocation Application | Word or PDF | | Notice of Effective Date for Relocation | Word or PDF | | Fiduciary Powers |
|---|
| Application Letter - Fiduciary Powers | Word or PDF | | Fiduciary Operating Plan - Instructions | Word or PDF | | Notice of Commencement of Fiduciary Activities | Word or PDF | | Senior Management Resolution on Surrender of Fiduciary Powers | PDF | | Voluntary Liquidation |
|---|
| Notice Letter - Standard Voluntary Liquidation | Word or PDF | | Resolution to Voluntarily Liquidate | Word or PDF | | Voluntary Liquidation - Sample Public Notice | Word or PDF | | Liquidation - Interim Progress Report | Word or PDF | | Liquidation - Final Report | Word or PDF | | Capital Equivalency Deposit |
|---|
| Capital Equivalency Deposit Agreement | Word or PDF | | Request to Change Depository Bank | Word or PDF | | Request for Reduction in CED Account Balance | Word or PDF | | Other Changes in Activities and Operations |
|---|
| Notice of Change in Activities or Operations | Word or PDF | | Cover Letter for a Change in Control | Word or PDF | | Senior Management Resolution or Conversion of a Federal Branch or Agency to a State-Licensed Operation of a Foreign Bank | Word or PDF |
|
