Form Member Director Fo Member Director Fo FHFA Form 131 - Federal Home Loan Bank Member Director E

FEDERAL HOUSING FINANCE AGENCY
Federal Home Loan Bank
Member Director
Eligibility Certification Form

FHFA Form #131
(04/2022)

INSTRUCTIONS

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This Federal Home Loan Bank Member Director Eligibility Certification Form must be completed by
individuals wishing to accept a nomination to stand for election as a member director of the Federal Home
Loan Bank of
(Bank) or to be considered for appointment by the Bank’s board to fill a
member directorship that has become vacant. It must also be completed annually by each incumbent member
director. Your responses to the questions on this Form will assist the Bank in verifying that you meet the
eligibility requirements to serve as a member director. Please complete and execute this Form and return
it to the Bank on or before
.
You are eligible to serve as a member of the Bank only if you meet all of the following requirements:
· You are a citizen of the United States.
·

You are an officer or director of a member institution of the Bank:
o That was a member of the Bank as of December 31,
; and
o Whose voting state for purposes of Bank directorship elections is the state that is represented by
the directorship for which you have been nominated; and

·

Each member of the Bank for which you are an officer or director is in compliance with all of its
applicable minimum capital requirements established by its primary regulator (this requirement does not
apply in the case of any member for which you are an officer or director that does not have capital
requirements established by a primary regulator, such as a non-depository community development
financial institution).

These eligibility requirements may be found in sections 7(a) and (b) of the Federal Home Loan Bank Act, 12
U.S.C. 1427(a) and (b), and in Federal Housing Finance Agency regulations at 12 CFR 1261.5(a) and (b).

Please follow the instructions below appropriate for the purpose for which you are completing this Form.

NOMINEES IN THE ANNUAL ELECTION CYCLE
If you have been nominated to stand for election as a member director of the Bank you must complete and
execute this Form and submit it to the Bank on or before the date specified by the Bank to accept the nomination.
If you do not submit a completed and executed Form by that date, you will be deemed to have declined the
nomination. By law, the Bank may not permit a directorship nominee to stand for election unless it has verified
that the nominee is legally eligible to serve in the directorship for which he or she has been nominated. Further,
the Bank may neither declare elected any nominee nor seat any director-elect whom it has reason to know is
ineligible to serve.
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CANDIDATES TO FILL A VACANT MEMBER DIRECTORSHIP
If the Bank’s board of directors is considering you as a candidate to fill the unexpired term of office of a vacant
member directorship on the Bank’s board, you must complete and execute this Form and return it to the Bank on
or before the date specified by the Bank. If you fail to submit a completed and executed Form by that date, or if
you submit a Form that does not adequately demonstrate that you meet all applicable eligibility requirements, the
Bank may determine that you are ineligible to serve, in which case the Bank’s board would be prohibited by law
from electing you to fill the vacant directorship. By law, the Bank’s board may not elect any person to fill a
vacant directorship unless it has verified that the individual is legally eligible to serve in that directorship.
ANNUAL ELIGIBILITY CERTIFICATIONS BY INCUMBENT DIRECTORS
The Bank is required by law to solicit information from its incumbent directors annually to verify that each
director remains in compliance with the applicable statutory and regulatory eligibility requirements. During each
calendar year that you are an incumbent member director, you must complete and execute this Form and return it
to the Bank on or before the date specified by the Bank. If you fail to submit a completed and executed Form by
that date, or if you submit a Form that does not adequately demonstrate that you continue to meet all applicable
eligibility requirements, the Bank may determine that you are ineligible to serve, in which case it would be
required by law to declare your directorship vacant.
PERSONAL INFORMATION
Please provide your personal information as indicated in Questions 1 – 4.

1. Full Name:
2. Other Names Used or Known by:
3. Contact Information:
Phone Number:
Home:

Office:

Cell:

E-mail Address:
Mailing Address:

Number/Street (or PO Box)

City

State

ZIP Code

ELIGIBLITY REQUIREMENTS
Please answer Question 4 – 6, which pertain to your compliance with the statutory and regulatory eligibility
requirements for member directors, in full. You may continue your answers onto additional pages, if necessary,
each of which shall be attached to, and deemed a part of, this Form.
4. Citizenship.
Are you a citizen of the United States?

Yes
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No

5.

Primary Member Affiliation. Please provide the following information about the entity you serve as an
officer or director that is a member of the Bank on whose board you serve or have been nominated to
serve:
Name of the member:
FHFA ID number of the member:
Voting state in which the member is located:
Your title:
Your business address at the member:

Number/Street

City

State

ZIP Code

Does this member comply with all applicable minimum capital requirements established by its primary
regulator?
Yes
6.

No

Not Applicable

Other Member Affiliations. Please provide the following information about any other entity you serve
as an officer or director that is a member of the Bank on whose board you serve or have been nominated
to serve (if more than one, please provide the information on a separate sheet, which shall be attached to,
and deemed a part of, this Form):
A. Other than the institution you listed in response to Question 5, do you serve as an officer or director
of any other institution that is a member of this Bank?
Yes

No

B. If you answered Yes to Question 6A, please provide the following information for each member of
the Federal Home Loan Bank that you serve as an officer or director:
Name of the member:
FHFA ID number of the member:
Your title:
Does this member comply with all applicable minimum capital requirements established by its
primary regulator?
Yes

No

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Not Applicable

By executing this Form, you are certifying that the information you have provided is true, correct, and
complete to the best of your knowledge and that you understand that you have a continuing obligation to
inform the Bank of any facts that may call into question your eligibility or ability to serve as a Bank
director. You further acknowledge that the Bank and the Federal Housing Finance Agency may perform a
background check on you, including without limitation regarding any information disclosed herein.

Signature/Date:

Reminder: Apply your electronic signature above here. If you physically sign, please include date.

Privacy Act Statement: In accordance with the Privacy Act (5 U.S.C. 552a), the following notice is provided.
This information is solicited under authority of 12 U.S.C. 1427(a) and (b) and 12 CFR 1261.5, 1261.7, and
1261.10 to 1261.13. Furnishing the information on this Form is voluntary, but failure to do so may result in your
not meeting the statutory and regulatory eligibility requirements to serve as a Federal Home Loan Bank member
director. The purpose of this information is to facilitate the timely determination of your eligibility to serve as a
member director. Information may be disclosed in accordance with the routine uses identified in FHFA-System
of Records Notice FHFA-8 Federal Home Loan Bank Directors, which may be found here.

Paperwork Reduction Act Statement: Notwithstanding any other provision of the law, no person is required to
respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information
subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a
currently valid OMB Control Number.

OMB No. 2590-0006
Expires 07/31/2024

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