2a Qualified Issuer Application - Appendix QI-2-E Notice of

Appendix: Examples of Document and Chart Formatting
QI-2-E. Notice designating Qualified Issuer signed by Certified CDFI

Notice Designating Qualified Issuer
Instructions: Every Qualified Issuer Applicant must be designated by at least one Certified
CDFI. This form must be completed and signed by the Authorized Representative of the
designating Certified CDFI and submitted with the Qualified Issuer Application.
Designating Certified CDFI

Name of Designating Certified CDFI

EIN of Designating Certified CDFI

Certification Number of Designating Certified CDFI

Designation:
Pursuant to 12 U.S.C. 4703a, I hereby designate the following entity as Qualified Issuer under
the CDFI Bond Guarantee Program:

Name of Designate Qualified Issuer Applicant

EIN of Designated Qualified Issuer Applicant

Signature of Certified CDFI’s Authorized Representative
Printed Name:
Title:
Name of Certified CDFI:
Date:
OMB Control Number: 1559-0044