Pre-Exit Clearance/Transfer Record for Contractor Personnel

• Legal Form Number: FDIC Form 3700/25
• Section: Federal Deposit Insurance Corporation

Page of FDIC 3700/25 (12-21)

Federal Deposit Insurance Corporation

PRE-EXIT CLEARANCE/TRANSFER RECORD

FOR CONTRACTOR PERSONNEL

PRIVACY ACT STATEMENT

The FDIC is authorized to request this information from you by 12 U.S.C § 1819. The FDIC will use this information to confirm that all

of your FDIC-issued property has been returned and financial obligations to FDIC have been settled. The information you provide

may be provided to appropriate Federal, state, local or foreign agencies and law enforcement authorities; to a court, administrative

tribunal, or a party in litigation; and to contractors, agents and other third parties as authorized by law and in accordance with any of

the other routine uses described in FDIC 30-64-0012, Financial Information Management Records System of Records available at

www.fdic.gov/about/privacy. Furnishing the requested information is voluntary, but failure to provide the requested information in

whole or in part may delay or prohibit any further payment on your contract with the FDIC. If you have questions or concerns about

the collection or use of the information, you may contact the FDIC's Chief Privacy Officer at Privacy@fdic.gov.

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