Form TA-1 Transfer Agent Registration and Amendment

Transfer Agent Registration and Amendment Form

Form TA-1 FDIC OMB 8-31-2007

Transfer Agent Registration and Amendment Form

OMB: 3064-0026

Document [doc]
Download: doc | pdf

OFFICIAL USE










Expiration

REG/FILE NUMBER








Agency

OMB No.

Date










FDIC

3064-0026

08-31-2007










FRB

7100-0099

04-30-2007










OCC

1557-0124

11-31-2007


TRANSFER AGENT REGISTRATION AND AMENDMENT FORM

FORM TA-1


Please print or type responses. Complete all items for both registrations and amendments. Read all instructions before completing the form. Detailed guidance for each item on Form TA-1 appears in Part II (Special Instructions) of the instructions for Form TA-1.



1.

APPROPRIATE REGULATORY AGENCY

( Check One )






Comptroller of the Currency


Federal Deposit Insurance Corporation


Board of Governors of the Federal Reserve System


2.

FILING STATUS OF THS FORM

( Check One )






Registration











Amendment to Registration









3.

FULL NAME OF REGISTRANT










     









Previous Name of Registrant (if Being Amended for Name Change)





     



4.

FINANCIAL INDUSTRY NUMBER STANDARD (FINS) NUMBER






 

 

 

 

 

 



5.

MAIN OFFICE LOCATION OF REGISTRANT







Number and Street

City

9-Digit ZIP Code




     



6.

MAILING ADDRESS







Number and Street

City

9-Digit ZIP Code




     




     



7.

TELEPHONE NUMBER








Area Code

Number











   

     

     






8.

PRINCIPAL LOCATION (OF THE REGISTRANT) WHERE TRANSFER AGENT PROCESSING ACTIVITIES ARE LOCATED



Number and Street

City

9-Digit ZIP Code




     



9.

LIST ALL OTHER LOCATIONS (OF THE REGISTRANT) WHERE TRANSFER AGENT PROCESSING ACTIVITIES ARE CONDUCTED



Number and Street

City

9-Digit ZIP Code




     




     




     



FDIC Form 6342/01 (11-98)

Word Template

Print Date: 04/10/2002


FORM TA-1 ( Page 2 )




10.

DOES REGISTRANT ACT ( OR WILL IT ACT ) AS A TRANSFER AGENT SOLELY FOR ITS OWN SECURITIES AND/OR SECURITIES OF AN AFFILIATE(S)?



Yes



No






11.

HAS THE REGISTRANT CONTRACTED TO HAVE AN OUTSIDE OGRANIZATION PERFORM TRANSFER AGENT FUNCTIONS IN THE REGISTRANT’S NAME? ( “Private Label” Servicing )



No






ARA-Assigned





If Yes, List the Name(s) of the Private Label Transfer Agents


Registered Transfer Agent Number





     


8

 

-

 

 

 

 

 





     


8

 

-

 

 

 

 

 





     


8

 

-

 

 

 

 

 




( ARA = “Appropriate Regulatory Agency” )





12.

DOES THE REGISTRANT PERFORM ANY PRIVATE LABEL TRANSFER AGENT SERVICES FOR ANOTHER REGISTERED TRANSFER AGENT?



No





ARA-Assigned





If Yes, List the Name(s) of the Named Transfer Agents


Registered Transfer Agent Number





     


8

 


 

 

 

 

 





     


8

 


 

 

 

 

 





     


8

 


 

 

 

 

 





     


8

 


 

 

 

 

 





     


8

 


 

 

 

 

 




( ARA = “Appropriate Regulatory Agency” )







13.

EXECUTION:

The Registrant submitting this Form, and the person executing it, hereby represent that all the information contained herein is true, correct, and complete.



ATTENTION:

Intentional misstatements or omissions of fact constitute Federal criminal violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).


14.

FULL NAME AND TITLE OF OFFICIAL RESPONSIBLE FOR FORM


( Print or Type )




[ First Name ] [ Full Middle Name ] [ Last Name ]


[ Title ]




     

     





15.

SIGNATURE OF OFFICIAL RESPONSIBLE FOR FORM

DATE























FDIC Form 6342/01 (11-98) Page 2

Word Template

Print Date:



File Typeapplication/msword
File TitleAgency
AuthorFDIC
Last Modified Byshanft
File Modified2007-07-10
File Created2007-07-10

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