2a Qualified Issuer Application-Appendix QI-2-E Notice of D

Appendix: Examples of Document and Chart Formatting 
QI‐2‐E. Notice designating Qualified Issuer signed by Certified CDFI 

Notice Designating Qualified Issuer
Instructions: Every Qualified Issuer Applicant must be designated by at least one Certified
CDFI. This form must be completed and signed by the Authorized Representative of the
designating Certified CDFI and submitted with the Qualified Issuer Application.
Designating Certified CDFI
Name of Designating Certified CDFI
EIN of Designating Certified CDFI
Certification Number of Designating Certified CDFI

Designation:
Pursuant to 12 U.S.C. 4713a, I hereby designate the following entity as Qualified Issuer under
the CDFI Bond Guarantee Program:

Name of Designate Qualified Issuer Applicant
EIN of Designated Qualified Issuer Applicant

Signature of Certified CDFI’s Authorized Representative
Printed Name:
Title:
Name of Certified CDFI:
Date:
OMB Control Number: 1559-0044
Expiration Date: 02/28/2025