After-the-Fact Notice - Subsidiary or Service Company

After-the-Fact Notice—Subsidiary or Service Company

Date

Licensing Manager, District

Comptroller of the Currency

Address

City, State, ZIP Code

Re: Notice of Subsidiary Activity, Bank Charter Number

Dear Licensing Manager:

On (insert date), we (established or acquired a subsidiary or commenced performing) new activities through an investment in an operating subsidiary (or bank service company).

We are eligible for the after-the-fact notice process for the investment we have made for the activity listed at 12 CFR 5.34(e)(5)(v)(___)(insert the appropriate activity cite: A-Y). The name and address of the subsidiary are: (insert).

The activity being conducted is: (insert complete description of the activity).

(If performing insurance activities (including brokers/dealers selling annuities that are considered insurance products under state law), describe the type of insurance activity the subsidiary or service company is engaged in and has present plans to conduct, and list for each state the lines of business for which the company holds, or will hold, an insurance license, indicating the state where the company holds a resident license or charter, as applicable.)

The activity will be performed at the: (insert main office, branch office, or other location).

The investment is: Amount $__________

Percent of Bank Capital __________

The bank represents and undertakes that the proposed activity is being conducted and will continue to be conducted according to the OCC policies contained in guidance issued for this activity.

I certify that the information contained in this filing has been examined carefully by me and is true, correct, and complete, and is current as of the date of this submission. I acknowledge that any misrepresentation or omission of a material fact constitutes fraud in the inducement and may subject me to legal sanctions provided by 18 USC 1001.

If you have any questions, contact (name, address, city, state, ZIP Code) at (telephone number).

Sincerely,

—Signature—

Name and Title