Independent Direct Federal Home Loan Bank Independent Director Annual Certi

FEDERAL HOME LOAN BANK
INDEPENDENT DIRECTOR
ANNUAL CERTIFICATION FORM
Full name: __________________________________________________________________
Federal Home Loan Bank of: ____________________________________________________
Every year, each incumbent independent Federal Home Loan Bank (Bank) director must certify
that he or she continues to meet all of the following requirements:
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United States citizen
Bona fide resident of a state in the geographic district of the Bank on whose board you serve
o your principal residence is located in that geographic district OR
o you own or lease a second residence in the district and are employed in the district
During your term of office, you and your spouse may not:
o serve as an officer of any Federal Home Loan Bank
o serve as an officer, employee, or director of any member or subsidiary of a member of the
Bank you serve, or any holding company that controls one or more members of the Bank
you serve if the assets of all such members constitute 35 percent or more of the assets of
the holding company, on a consolidated basis
o serve as an officer, employee, or director of any recipient of advances from the Bank you
serve, or any holding company that controls one or more recipients of advances from the
Bank you serve if the assets of all such recipients constitute 35 percent or more of the
assets of the holding company, on a consolidated basis
To be designated a public interest director, you must have more than four years experience
representing consumer or community interests on banking services, credit needs, housing, or
consumer financial protections
If you are not designated as a public interest director, you must have knowledge or
experience in one of the following: auditing and accounting, derivatives, financial
management, organizational management, project development, risk management practices,
or the law.

By executing this form, you are certifying that you continue to meet these
requirements and that the director application form you submitted previously,
or any amended certification form you submitted previously, is true, correct,
and complete to the best of your knowledge.

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Please check one box:

No changes have occurred.
Changes have occurred to my responses in these sections of my Form:
Personal information:

Eligibility information, including conflicts of interest:

Commitment to serve:

Personal integrity:

Independence:

Other changes:

Dated: ___________________________________
Signature: ____________________________________________________________________
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