Bank Service Company Application

Bank Service Company Application

Date

Licensing Manager, District

Comptroller of the Currency

Address

City, State, ZIP Code

Dear Licensing Manager:

Re: Bank Service Company, Bank Charter Number

We request approval to invest in the capital stock of a bank service company.

The name and address of the service company are: (insert).

The services will be performed only at locations in a state in which the investing national bank(s) could be authorized to perform them. (If not, state whether the Federal Reserve Board has approved an exception to this requirement.)

The bank service company and investing banks are all located in the same state. (If not, state whether the Federal Reserve Board has approved an exception to this requirement.)

The activity to be performed subject to this application will be: (completely describe the activity to be conducted, the expected effect on the bank's earnings and condition, and the legal basis supporting the permissibility of the activity.)

The amount of the investment is limited to 10 percent of the bank's capital and surplus and 5 percent of total assets. Specifically, the investment is:

Amount $__________

Percent of Capital and Surplus __________

Percent of Total Assets __________

(Add if appropriate) The principal investor is: (insert).

(Add if appropriate) The following supplementary information is provided to describe adequately the activity to be performed; the percentage of control by each investing bank; and the organizational structure, management, and relationships between the bank and the subsidiary: (insert).

The filing fee of $ is enclosed. We desire action on this application no later than (date).

I certify that the information contained in this filing has been examined carefully by me and is true, correct, and complete, and is current as of the date of this submission. Additionally, I agree to notify the OCC if the facts described in the filing change materially prior to receiving a decision. I acknowledge that any misrepresentation or omission of a material fact constitutes fraud in the inducement and may subject me to legal sanctions provided by 18 USC 1001.

If you have questions, contact (name, address, city, state, ZIP Code) at (telephone number).

Sincerely,

—Signature—

Name and Title

Enclosures