Operating Subsidiary Application

Operating Subsidiary Application

Date

Licensing Manager, District

Comptroller of the Currency

Address

City, State, ZIP Code

Re: Operating Subsidiary, Bank Charter Number

Dear Licensing Manager:

The bank intends to (establish or acquire a subsidiary or conduct) new activities through an investment in an operating subsidiary. The name and address of the subsidiary are: (insert). The activity will be performed at the: (Insert main office, branch office, or other location).

We request approval for an operating subsidiary (activity) as described as follows.

The bank owns more than 50 percent of the voting or similar type of controlling interest of the subsidiary. (Or describe how the bank controls or will control the subsidiary.)

The following information is provided to describe completely the activity to be performed, and the organizational structure, management, and relationships between the bank and the subsidiary, and any significant effect that the subsidiary will have on the bank's condition and earnings: (Insert complete description so the OCC may determine legality.)

The investment is: Amount $__________

Percent of Bank Capital __________

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

Enclosure