Proposal Form for Early Repurchase of CDCI Securities

PROPOSAL FORM FOR EARLY REPURCHASE OF CDCI SECURITIES
Please complete the following information and submit to cdci@treasury.gov prior to the submission deadline of
5:00PM ET, Friday, November 18, 2016. In addition to completing the information on the form, please
submit all requested additional/supporting documents as outlined in the notification letter1.
Further information regarding this form, the notification letter and the proposal process can be found here:
https://www.treasury.gov/initiatives/financial-stability/TARP-Programs/bank-investmentprograms/cdci/Pages/default.aspx. Any additional questions may be directed to cdci@treasury.gov.
INSTITUTION NAME:

UST NUMBER:

SUBMISSION DATE2:

RESUBMISSION: (CHECK IF APPLIES )

PRIMARY CONTACT

SECONDARY CONTACT

NAME:

NAME:

PHONE:

PHONE:

EMAIL:

EMAIL:

CDCI SECURITY

TYPE:
(CHECK )

CUMULATIVE
PREFERRED STOCK

SUBORDINATED
DEBENTURES

NON-CUMULATIVE
PREFERRED STOCK
DATE OF CDCI
INVESTMENT:

TOTAL AMOUNT
OUTSTANDING ($):

DIVIDEND OR INTEREST PAYMENTS

CURRENT RATE:

MOST RECENT
PAYMENT AMOUNT:

1

2

0.0%

RATE STEP-UP
DATE:

STEP-UP
RATE:

0.0%

MOST RECENT
PAYMENT DATE:

Notification letter refers to the letter sent on August 1, 2016 to all CDCI participants announcing the CDCI
wind-down plan and posted on Treasury's website at: https://www.treasury.gov/initiatives/financialstability/TARP-Programs/bank-investment-programs/cdci/Pages/default.aspx.
If this is the first proposal submission this will be recorded as your original submission date. Resubmissions
following a declined proposal must be submitted within 60 calendar days of the original submission date and prior to
5:00PM ET, Friday, November 18, 2016.

FAIR VALUE PROPOSAL
PROPOSED FACE VALUE OF SECURITIES
TO BE REPURCHASED ($): MINIMUM 50% OF OUTSTANDING
FAIR VALUE OFFERED FOR SECURITIES
TO BE REPURCHASED ($):
HAVE YOU CONSULTED WITH YOUR PRIMARY
REGULATOR REDARDING AN EARLY REPURCHASE?

EXPECTED REPURCHASE COMPLETEION DATE:

CERTIFICATION

Name of the Chief Executive Officer

(or Authorized Designee)

Signature of the Chief Executive Officer3

Title

Date of Signature

(or Authorized Designee)

3

By signing, the signatory is certifying that all information contained on the form and submitted as part of the
proposal process is accurate. This is also a certification that the institution meets all of the eligibility criteria
as set forth in the notification letter.

This information is being collected under OMB Control Number 1505-0223.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a valid control number. The time required to
complete this form is estimated to average 24 hours.