FDIC Contractor Representations and Certifications
| Legal Form Number | FDIC Form 3700/04 |
| Section | Federal Deposit Insurance Corporation |
FDIC 3400/04A (12-20)
OMB NUMBER: 3064-0072
EXPIRATION DATE: 03/31/2025
Page 1 of 8
FDIC
Contractor
Representations and
Certifications
CONTRACTOR NAME
SUBMITTED BY
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