OTS Form 1566 Notice for Preapproved Service Corporation Activity

OMB No. 1550-0013
Expiration Date: 6/30/2011

OFFICE OF THRIFT SUPERVISION
NOTICE FOR PREAPPROVED SERVICE CORPORATION ACTIVITY
PAPERWORK REDUCTION ACT STATEMENT
The Office of Thrift Supervision is obtaining this information pursuant to Section 12 C.F.R. § 559.4
in connection with its prior review of service corporation pre-approved activities. Public reporting
burden for this collection of information is estimated to average 15 minutes per response, including
the time for reviewing instructions and completing and reviewing the collection of information. If a
valid OMB Control Number does not appear on this form, you are not required to complete this
form. Send comments regarding this burden estimate or any other aspect of the collection of
information, including suggestions for reducing this burden, to Office of Thrift Supervision,
Corporate & International Activities, 1700 G Street N.W., Washington, D.C. 20552 and the Office
of Management and Budget, Paper Reduction Act Project (1550-0013), Washington, D.C. 20503.

OTS Form 1566
Revised June 2008

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OMB No. 1550-0013
Expiration Date: 6/30/2011

Docket Number: __________

OFFICE OF THRIFT SUPERVISION
NOTICE FOR PRE-APPROVED SERVICE CORPORATION ACTIVITY
TO: Office of Thrift Supervision

Date of Notice: ________________

We, the undersigned executive officer and secretary, pursuant to a majority vote of the members of
the board of directors of:
________________________________________________________________________________
Savings Institution Name
________________________________________________________________________________
Street Address of Savings Institution (include City, State, and Zip Code)

(Hereinafter the Institution), hereby provide notice to the Office of Thrift Supervision (OTS) that
the Institution intends to acquire or establish a service corporation to engage in the pre-approved
activity of ____________, pursuant to 12 C.F.R. § 559.4 and 559.11 and do hereby certify:
1. That the Institution shall comply with the applicable requirements of 12 C.F.R. § 559.4;
2. That, if applicable, the Institution has attached any additional information required,
pursuant to 12 C.F.R. § 516.220;
3. That the Institution has notified the FDIC, pursuant to 12 U.S.C. § 1828(m)(1), of the
establishment or acquisition of a service corporation and has attached a copy of the FDIC
notification; and
4. That we are aware the OTS may request additional information or may impose conditions
for the acquisition or establishment of a service corporation to engage in pre-approved
activities and may determine that the acquisition or establishment of a service corporation
to engage in pre-approved activities does not comply with 12 C.F.R. § 559.4.
__________________________________
Executive Officer

________________________________
Secretary

________________________________
Date of Receipt by OTS

OTS Form 1566
Revised June 2008

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