Interagency Charter and Federal Deposit Insurance Application

• Legal Form Number: FDIC 6200/05
• Section: Federal Deposit Insurance Corporation

FDIC 6200/05 (7-21)

FDIC OMB 3064-0001, Expiration 09/30/2022

OCC OMB 1557-0014, Expiration 0/31/2024

Federal Deposit Insurance Corporation

INTERAGENCY CHARTER AND FEDERAL DEPOSIT INSURANCE APPLICATION

STATEMENT OF BURDEN

Public reporting burden for this collection of information is estimated to average 250 hours per response (125 hours for

the charter application and 125 hours for the insurance application), including the time to review instructions, search, and

to review and complete the information collection. Send comments regarding this burden estimate or any other aspect of

this collection of information, including suggestions for reducing this burden to: Office of the Executive Secretary, Federal

Deposit Insurance Corporation, 550 17th Street, NW, Washington, DC 20429; or Licensing Policy and Systems Division,

Comptroller of the Currency, 250 E Street, S.W., Washington, DC 20219; and to the Office of Management and Budget,

Paperwork Reduction Project, Washington, DC 20503.

An organization or a person is not required to respond to a collection of information unless it displays a currently valid

OMB control number.

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FDIC 6200/05 (7-21)

FDIC OMB 3064-0001, Expiration 09/30/2022

OCC OMB 1557-0014, Expiration 0/31/2024

GENERAL INFORMATION AND INSTRUCTIONS

Preparation and Use

This application is used to effect a transaction under:

■ Sections 5 and 6 of the Federal Deposit Insurance Act (FDIA), as amended (12 U.S.C. 1815, 1816), for federal

deposit insurance.

■ Section 5(e) of the Home Owners’ Loan Act (HOLA), as amended (12 U.S.C. 1464(e)), for a federal savings

association charter.

■ The National Bank Act, as amended (12 U.S.C. 21 et seq.), for a national bank charter.

■ The state law for applying for state depository charters, as approved by state regulatory authorities.

All questions must be answered with complete and accurate information that is subject to verification. If the answer is

"none," "not applicable," or "unknown," so state. Answers of "unknown" should be explained.

The questions in the application are not intended to limit the Applicant's presentation nor are the questions intended to

duplicate information supplied on another form or in an exhibit. For such information, a cross reference to the information

is acceptable. Any such cross-reference must be made to a specific cite or location in the documents, so the information

can be located easily. Supporting information for all relevant factors, setting forth the basis for Applicant's conclusions,

should accompany the application. The regulatory agency may request additional information.

This application form collects information that the regulatory agencies will need to evaluate a charter or insurance

application. While most of the information will be available when the organizers submit the application, some information

will not be available at that time. Each agency has specific purposes and different timing requirements in collecting some

of this information; for example, receipt of the organizers’ draft policies. For any question about when to submit a specific

item, organizers should contact the appropriate regulatory agencies to discuss the specific timing for submission.

The regulatory agency must consider the applicable statutory requirements set forth in the preceding provisions, as well

as applicable regulatory requirements, when acting on this application. For additional information regarding these

statutory and regulatory requirements, as well as processing procedures and guidelines and any supplemental

information that may be required, please refer to the appropriate regulatory agency's procedural guidelines [i.e.,

Comptroller’s Corporate Manual, the OCC’s rules and regulations (12 C.F.R. 5, 143), the FDIC's rules and regulations (12

C.F.R. 303, 309) and Statement of Policy on “Applications for Deposit Insurance”, or the application guidelines for the

state in which the Applicant seeks a state charter]. The Applicant may contact the agency directly for specific instruction

or visit their websites at www.fdic.gov, www.occ.treas.gov, and www.csbs.org, (through “Links” to each state banking

department).

Notice of Publication

The Applicant must publish notice of the proposed organization in a newspaper of general circulation in the community or

communities in which the proposed financial institution will be located. Contact the appropriate regulatory agency for the

specific requirements of the notice of publication.