Form FDIC-2120/16 Applicant Certification Statement

Certification of Compliance with Mandatory Bars to Employment

Form 2120-16 Applicant Certification

Certification of Compliance with Mandatory Bars to Employment

OMB: 3064-0121

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3064-0121 can be found here:

2023-06-14 - No material or nonsubstantive change to a currently approved collection

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File Type	application/pdf
File Title	2120/16, Application Certification Statement
Subject	For questions regarding this form, email Forms@fdic.gov.
Author	S. Todd Hamme
File Modified	2021-11-08
File Created	2021-11-08