NCUA 9600 Information to be Provided in Support of the Application

INFORMATION TO BE PROVIDED IN SUPPORT OF THE APPLICATION OF A
STATE CHARTERED CREDIT UNION FOR INSURANCE OF ACCOUNTS
Existing credit unions must complete the entire application. All other applicants do not
have to complete questions 8, 11, 12, 13, 15, and 16.
1. Show the location of the credit union's books and records.
Street Address
City, State, Zip Code
Telephone No.
2. Show the date (M/D/Y) in which the credit union was chartered:

/

/

3. Attach a copy of the credit union's field of membership as shown in the charter,
articles of incorporation and/or bylaws, as amended to date. Please identify it
as the first schedule in the consecutive number sequence as discussed in the
instructions. Schedule No.
4. Potential membership (number of total persons
who could be served including present members).
5. Identify charter type (e.g., single common bond,
multiple common bond, community).
6. Does the credit union operate under standard
bylaws provided by the state supervisory authority?

a. Attach a copy of the current official bylaws under which the credit
union operated. Schedule No.
7. Is the credit union under any administrative
restraints by the State Supervisory Authority?
a. Explain fully on an attached schedule. Schedule No.

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8. Attach a copy of the latest State supervisory authority examination. Copies of any
correspondence from the accountant's report if made in lieu of a State supervisory
authority examination. Copies of any correspondence from the State supervisory
authority which accompanied the examination report should also be included.
9. Attach copies of the Balance Sheet and Statement of Income and Expense (or
Financial and Statistical Report) for the month preceding the date of this application
and for the same month of the preceding year. Schedule Nos.
10. Reserves: Show below the requirements of the State law and/or your bylaws for
transfer of earnings to reserves (either monthly or at the end of each accounting
period).

11. Delinquent Loans and Charged-off Loans
a. Attach a copy of the delinquent loan list as of the month-end preceding the date

of this application. See instructions pertaining to Item No. 11a. Schedule No.
b. List below the requested information on delinquent loans for the latest four calendar

quarters preceding the date of the application (March 31, June 30, September 30
and December 31). Also show total share and loan balances for all members for
the same period.
(a)
*Other Delinquent
Categories

(b)
Delinquent
Categories

Date

Date

Date

Date

2 to less than
6 months
6 to less than
12 months

12 months and
over

Totals

Share Balances

Loan Balances

* See instructions pertaining to Item. No. 11 b.

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c.List below the requested information on loans charged off during the last three years
and the current year. List total of all reserves both revocable and irrevocable for the
the same period as (balance at year-end or current period).
Year

Year

Year

Current Year
To Date

* Totals Since
Organization

Total
Charged Off
Total
Recovered

Net
Charged Off
*If this information is available.
12. Does the credit union have any unrecorded or contingent
liabilities,(including pending law suits or civil actions)?

Yes
Complete a.
a. List on an attached schedule the complete description of such liabilities,
including amounts, status of the items, and a description of the
circumstances creating the liabilities or contingent liabilities. Schedule No.
13. Do any asset accounts other than loans to members,
investments, and real estate have actual values less
Yes
than the book values shown on the Balance Sheet?
List on a separate schedule a description of such assets, showing at least
the following information; account number, description of item, book value
and actual value. Schedule No.

No

No

14. List below or on an attached schedule, any investments or real estate as
discussed in the instructions pertaining to Item No. 14. Schedule No.
Attach a copy of the credit union's current investment policies.
Investments/Loans to Credit Union Service Organization (CUSO) should be
listed separately.
Description of Item

Current Market Value

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Current Book Value

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15. Individual Share and Loan Ledgers:
a. Were the totals of the trial balance of the individual share
and loan ledgers in agreement with the balances of the
respective general ledger control accounts as of the
month-end preceding the date of this application?

Yes

No

b. What are the differences as of the month and preceding
the date of this application?
Shares

Loans

Balances in General Ledger
Totals of the trial balance of
the individual ledgers

Differences
16. Supervisory Committee
a. What is the effective date of the last complete
comprehensive annual audit performed by the
supervisory committee? Effective Date:
(1) If the effective date of the annual audit is not within
the last 18 months what is the supervisory committee's
target date for completion of a comprehensive audit? Date:
b. Show the effective date of the supervisory committee's
last controlled verification of all members' accounts:
Effective Date:
(1) If all members' accounts have not been verified under
controlled conditions during the last two years, what is the
supervisory committee's target date for completion of the
verification program? Date:
c. If it is necessary to complete either 16a(1) or 16b(1); please describe the
directors' plans for seeing that the target dates are met. (Discuss below or
on an attached schedule.). Schedule No.

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17. List below the credit union's surety bond coverage.
a. Name of carrier
b. Standard form number of the bond (i.e.
23, 576, 577, 578, 581, 562 CU-1, other)
c. Basic amount of coverage
d. Bond premium paid to (date)
e. What is the amount of coverage required
by State Law or your bylaws?
f. Riders to the bond (list below) (i.e., faithful
performance, forgery, misplacement, etc.)
18. Does the credit union render any services to or
perform any functions on the behalf of the members,
non-members, organizations, or the public other than
the usual savings and loan services for members?

Yes

No

a. Attach a schedule describing each activity in full. Schedule No.
19. Does the board of directors or management know of
any adverse economic condition that is affecting or
will affect the credit union's present or future operation
or that of the sponsor organization?

Yes

No

Yes

No

a. Attach a schedule describing the condition and its possible
effect on the credit union's future. Schedule No.
20. To the best of the credit union's knowledge and belief,
has any director, officer, committee member, or
employee been convicted of any criminal offense
involving dishonesty or breach of trust?

a. Attach a statement describing the circumstances. Schedule No.

21. Lending policies and practices:
a. Complete the following schedule showing the present policies
and practices on loans to members.
b. Complete the following schedule of largest loans with the
attached instructions pertaining to Item No. 21

LENDING POLICIES AND PRACTICES
Maximum
Loan
Amount
1. Credit Union Policies and
Practices
a. Unsecured Loan Limits

Maximum
Period
of
Repayment

Required
Amount of
Down Payment
(Equity)

b. Secure Loan Limits
(1) New Auto Collateral
(2) Used Auto Collateral

(3) Real Estate
(a) First Mortgage
(b) Second Mortgage
(4) Comakers
(5) Others (describe)

c. Loans to Organizations
d. Loans to Directors, Officers,
or Committee Members
2. State Credit Union Law; Bylaws

a. Unsecured Loan Limits
b. Secured Loan Limits
c. Loans to Directors, Officers,
or Committee Memebrs
List on an attached page, any additional policies, including the interest rates applied to
members' loans and the method of assessing and accounting for interest income,
i.e.: add-on, discount or unpaid balance.
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SCHEDULE OF LARGEST LOANS
Complete this form as discussed in the instructions pertaining to Item 21b.
Status of
Appraised Description
Unpaid
Repayment
Account
Repayment
Collateral
Loan
Period
of
No.
Delinquent
∗
Bal.
(No. Months) Current (No. Months)
Collateral
Value

*If there is more than one type of collateral assign value to each type.

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CREDIT UNION SERVICE ORGANIZATION
(CUSO)
1. Name of CUSO
2. Date of CUSO's Organization
(Date of obtaining charter from State)
3. Types of organization (check one)
a. General Partnership

c. Joint Ownership

b. Limited Partnership

d. Corporatation

4. Owners of CUSO (list name, charter number if FCU,
and percentage of ownership, if possible).
a. Name

b. Name

Charter Number (if FCU)

Charter Number (if FCU)

%

%

5. Capitalization (list investors and amount of
investment in CUSO).

a. Name

b. Name

Charter Number (if FCU)

Charter Number (if FCU)

Amount

Amount

6. List all known services which are being offered by
CUSO (be as specific as possible).

7. Comments (include all other pertinent information, if applicable,
not previously discussed).

8. Attach the latest Financial and Statistical Report of CUSO, if available.

FORM 9600 INSTRUCTIONS
APPLICATION OF A STATE CHARTERED CREDIT UNION
FOR INSURANCE OF ACCOUNTS
absorption of losses relating to loans
The application and all supporting
to members.
documents should be prepared,
photocopied, and submitted in
Item No. 11a: The delinquent loan list
accordance with the procedures
requested should include, for each
outlined in the letter that transmitted
delinquent loan, the account number of
these instructions. Additional
the borrower, date of loan, original
schedules may be included if deemed
amount of loan, unpaid balance, date
appropriate.
of last payment of principle, excluding
transfers from pledged shares,
Existing credit unions must complete
collateral, and comments regarding the
the entire application. All other
collectibility of each loan in the
applicants do not have to complete
categories 6 months to less than 12
questions 8, 11, 12, 13, 15, and 16.
months and 12 months and over.
Payments of interest only should be so
Existing credit unions must submit
identified.
current policies and financial
statements as noted in the application.
Item No. 11b: The schedule provided
All other applicants must submit
for the delinquent loan information is
proposed policies and pro forma
set up in delinquency categories of 2
financial statements for the first and
months to less than 6 months, 6 to less
second year of operation.
than 12 months, and 12 months and
over. Credit unions that compute
When an item specifies that a schedule
delinquency using categories other
should be prepared and attached,
than shown in column (b) may use
please assign a schedule number in
these other categories and show them
consecutive order, starting with
in column (a). Credit unions using
number one. Please show the schedule
column (a) need not show the
number at the top right-hand corner of
delinquencies in the column (b)
the schedule.
categories. It is not necessary to report
on loans which are delinquent less
Some of the items are self-explanatory
than 2 months.
and require no special instructions.
Other items, however, need special
Adverse Trends: If items 8, 9, or 11
explanations, definitions, and
indicate adverse trends such as
instructions for completion. These are
significant decreases in shares, loans
listed below, identified by the same
or reserves, increases in loan
item numbers as appear in Exhibit A.
delinquency or loan charge-offs, or
unresolved serious exceptions shown
Item No. 10: Reserves: The term
in the State examination report, the
"reserves" means that account, or
credit union may attach an explanation
accounts, which represents
and identify it as "Explanation of
segregated portions of earnings as
Adverse Trends or Unresolved
provided by the law, bylaws, and/or the
credit union's management for the
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Examination Exceptions" and assign it
a schedule number.
Item No. 14: This item need be
completed only if the credit union
owns any of the following:

below has been shown. The number of
such loans to be listed will be
determined as follows:

A. Investments in U.S. Government
securities guaranteed as to
principle and interest or Federal
Agency securities, the market value
of which is now less than the book
value.
B. Real estate other than that used
entirely for the credit union's own
office(s).
C. Other investments of any type
except:
1. Loans to other credit unions.
2. Certificates of, or accounts in,
federally insured financial
institutions.
3. Deposits or accounts in
corporate credit unions.
If corporate bonds are listed, please
show maturity date, rate of interest on
bonds and current yield rate.
If stocks are listed, please show
number of shares and bid price.
Please identify the source of the
market valuation information and the
date of such information.
Item No. 21b: In selecting the largest
loans for this Exhibit, list the largest
outstanding unpaid loan balance and
proceed in descending order by dollar
amount until the number specified

If your
credit
union has
the
following
no. of
outstanding
loans

You should
list the
following
no. of
the largest
unpaid
balances

Under 100
100 to 199
200 to 299
300 to 399
400 or more

5
10
15
20
25

If any of the above loans are
delinquent, please show the number of
months delinquent in the appropriate
"Status of Re-payment" column.
Complete the Credit Union Service
Organization (CUSO) schedule for each
investment/loan to a CUSO.
TERMINATION OF INSURANCE
Should the credit union, after obtaining
insurance of member accounts, desire
to terminate its insured status, this
could be accomplished by complying
with the provisions of Section 206(a),
(c) and (d) of Title II of the Federal
Credit Union Act. This action would
require approval by a vote of the
majority of the members, and ninety
days written notice of the proposed
termination date to NCUA. Member
accounts would continue to be insured
for one year following termination of
insurance and the insurance premium

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would be paid during that period. After
termination of insurance, the credit
union shall give prompt and
reasonable notice to all members
whose accounts are insured that it has
ceased to be an insured credit union.
Sections 206(a)(2) and 206(d)(2) and (3)
of the Act provide that an insured
credit union may also terminate its
insurance by converting from its status
as an insured credit union under the

Act to insurance from a corporation
authorized and duly licensed to insure
member accounts. In this event,
approval is required by a majority of all
the directors and by affirmative vote of
a majority of the members voting,
provided that at least 20 percent of the
members have voted on the
proposition. Under this provision for
termination, insurance of member
accounts would cease as of the date of
termination.

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APPLICATION AND AGREEMENTS FOR INSURANCE OF ACCOUNTS
STATE CHARTERED CREDIT UNION
TO: The National Credit Union Administration Board
The

Date

Credit Union,

Insurance Certificate Number

(if applicable)

(mailing address)
(city)(state)(zip code)
applies for insurance of its accounts as provided in Title II of the Federal Credit
Union Act, and in consideration of the granting of insurance, hereby agrees:
702 of NCUA's regulations, and to
maintain such special reserves as
the NCUA Board may be regulation
or on a case-by-case basis
determine are necessary to protect
the interests of members. Any
waivers of the statutory reserve or
full and fair disclosure
requirements or any direct charges
to the statutory reserve other than
loss loans must have the prior
written approval of the NCUA
Board. In addition, corporate credit
unions shall be subject to the
reserve requirements specified in
Part 704 of NCUA's regulations.

1. To permit and pay the cost of such
examinations as the NCUA Board
deems necessary for the protection
of the interests of the National
Credit Union Share Insurance Fund.
2. To permit the Board to have access
to all records and information
concerning the affairs of the credit
union, including any information or
report related to an examination
made by or for any other regulating
authority, and to furnish such
records, information, and reports
upon request of the NCUA Board.
3. To possess such fidelity coverage
and such coverage against
burglary, robbery, and other losses
as is required by Parts 713 and 741
of NCUA's regulations.
4. To meet, at a minimum, the
statutory reserve and full and fair
disclosure requirements imposed
on Federal Credit Unions by Part

5. Not to issue or have outstanding
any account or security the form of
which has not been approved by
the NCUA Board, except accounts
authorized by state law for state
credit unions.

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from sources other than other
credit unions and public units, such
nonmember accounts shall be
identified as nonmember shares or
deposits on any statement or report
required by the NCUA Board for
insurance purposes. Immediately
after a state-chartered credit union
receives notice from NCUA that its
member accounts are federally
insured, the credit union will advise
any present nonmember share and
deposit holders by letter that their
accounts are not insured by the
National Credit Union Share
Insurance Fund. Also, future
nonmember share and deposit fund
holders will be so advised by letter
as they open accounts.

6. To maintain the deposit and pay the
insurance premium charges
imposed as a condition of
insurance pursuant to Title II (Share
Insurance) of the Federal Credit
Union Act.
7. To comply with the requirement of
Title II (Share Insurance) of the
Federal Credit Union Act and of
regulations prescribed by the NCUA
Board pursuant thereto.
8. For any investments other than
loans to members and obligations
or securities expressly authorized
in Title I of the Federal Credit Union
Act, as amended to establish now
and maintain at the end of each
accounting period and prior to
payment of any dividend, an
Investment Valuation Reserve
Account in an amount at least equal
to the net excess of book value over
current market value of the
investments. If the market value
cannot be determined, an amount
equal to the full book value will be
established. When, as of the end of
any dividend period, the amount in
the Investment Valuation Reserve
exceeds the difference between
book value and market value, the
board of directors may authorize
the transfer of the excess to
Undivided Earnings.
9. When a state-chartered credit union
is permitted by state law to accept
nonmember shares or deposits

10. In the event a state-chartered credit
union chooses to terminate its
status as a federally-insured credit
union, then it shall meet the
requirements imposed by Sections
206(a)(1) and 206(c) of the Federal
Credit Union Act and Part 741.208
of NCUA's regulations.
11. In the event a state-chartered credit
union chooses to convert from
federal insurance to some other
insurance from a corporation
authorized and duly licensed to
insure member accounts, then it
shall meet the requirements
imposed by Sections 206(a)(2),
206(c), 206(d)(2), and 206(d)(3) of
the Federal Credit Union Act and
any other applicable federal law.

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In support of this application we submit the following schedules:
Schedule No. and Title

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CERTIFICATIONS AND RESOLUTIONS
We, the undersigned, certify that we are the duly elected and qualified presiding
officer and recording officer of the credit union and that at a properly called and
regular or special meeting of its board of directors, at which a quorum was
present, the following resolutions were passed and recorded in its minutes:
We, the undersigned, certify to the correctness of the information
submitted.
Be it resolved that this credit union apply to the National Credit Union
Administration Board for insurance of its accounts as provided in Title II
of the Federal Credit Union Act.
Be it resolved that the presiding officer and recording officer be
authorized and directed to execute the Application and Agreement for
Insurance of Accounts as prescribed by the NCUA Board and any other
papers and documents required in connection therewith and to pay all
expenses and do all such other things necessary or proper to secure
and continue in force such insurance.
We further certify that to the best of our knowledge and belief no
existing or proposed officer, committee member, or employee of this
credit union has been convicted of any criminal offense involving
dishonesty or breach of trust, except as noted in attachments to this
application. We further agree to notify the Board if any existing,
proposed or future officer, committee member or employee is indicted
for such an offense.

(Signature) Chairperson, Board of Directors
(Print or type Chairperson’s Name)
(Signature) Secretary, Board of Directors
(Print or type Secretary's Name)
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