Application for Noncontrolling Investment

noncontrolling investment application

national bank identifying information

Charter No.:

Bank Name (exact corporate title):

Street Address:

City: County: State: ZIP:

contact person

Requests for additional information or other communications should be directed to:

Name:

Title:

Street Address:

City: State: ZIP:

Phone: Fax: E-mail:

equity investment details

The activity will be performed at:

Main office

Branch location

Other location

Date of Investment: (mm/dd/yyyy)

Investment Made: Directly

Through an operating subsidiary

application details

To determine permissibility, completely describe the structure of the investment and the activity or activities to be performed. If the activity is not permitted under a regulatory provision or that which has received prior OCC approval, explain why the activity is a permissible activity for a national bank and why the bank should be permitted to hold a noncontrolling investment in an enterprise engaged in that activity.

If the applicant is submitting an application because it is not well capitalized and well managed as of the time of its investment, provide its most recent ratings.

The following information is provided to describe how: 1) the bank can prevent the enterprise from engaging in activities not contained in 12 CFR 5.34(e)(5)(v) or in published OCC precedent approving a noncontrolling investment by a national bank or its operating subsidiary, or how the bank has the ability to withdraw its investment; and 2) the investment is convenient and useful to the bank in carrying out its business and not a mere passive investment unrelated to the bank’s banking business.

Is this the initial affiliation of the bank with a company engaged in insurance activities? (including a broker dealer selling annuities that are considered insurance products under state law?)

YES NO

If yes, describe the type of insurance activities that the company is engaged in and has present plans to conduct:

If yes, list for each state, the line of business that the company holds or will hold a resident license or charter for (enter additional lines as needed):

1) Line of Business:

State:

2) Line of Business:

State:

3) Line of Business:

State:

certification and signature

In connection with the investment, the bank certifies that:

• Its loss exposure is limited as a legal matter and the bank does not have open-ended liability for the obligations of the enterprise.

• The enterprise in which the bank is investing agrees to be subject to OCC supervision and examination and subject to the limitations and requirements of 12 USC 1820a and 1831v.

• 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 the 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.

I/We desire OCC action on this application no later than: (mm/dd/yyyy)

Signature: ______________________________________

Print or type Name: ______________________________

Title: ___________________________________________

Date: ___________________________________________