Liquidation - Final Report

Liquidation—Final Report

Federal Branch, Limited Federal Branch, Federal Agency Identifying Information

OCC License No. Date Liquidation Started ______________

Date Liquidation Completed ___________

Name (exact corporate title of bank)

Address ___________________________________________________________ (office address, street, city, state, ZIP Code, country)

Liquidating Agent/Correspondent Identifying Information

Name ________________________________________________________________

Address _______________________________________________________________

City State ZIP Code _______________

Phone No. Fax No. E-Mail _____________

[If applicable] The liquidation occurred because of an acquisition of the assets and liabilities by (name the acquiring institution).

I/We, the undersigned, being the (liquidating agent/liquidating committee), certify the attached* report of assets and liabilities to be a true statement, to the best of my/our knowledge and belief. Please release the Capital Equivalency Deposit (CED) held for the benefit of the OCC to (name of foreign bank).

Executed this of , .

(Liquidating Agent) (Correspondent for Committee)

(If there is a liquidating committee, every member should sign.)

*NOTE: The referenced report of assets and liabilities must be certified by a CPA and should reflect zero balances with the exception of the CED account.