NCUA 4000 Conversions of State Charter to Federal Charter (FCU Inv

OMB No. 3133-0015

CONVERSION OF STATE CHARTER TO FEDERAL CHARTER
FEDERAL CREDIT UNION INVESTIGATION REPORT
This report must be filled in completely and submitted with the other completed forms listed
in Chapter 4 and in the instructions for this form.
A. INFORMATION FOR CHARTER AND BYLAWS
1. Proposed Name:
Second Choice of Name:
2. Contact Person:
Bus. Tel. No./Area Code:
Res. Tel. No./Area Code:
3. The credit union will remain its office at:

4. Permanent Mailing Address of CU:





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5. Define proposed field of membership
(Attach a copy of current state charter
field of membership)
6. The board will have (an odd number 5 to 15)
members; the credit committee (an odd number, 3 to 7)
members; the supervisory committee (3 to 5)
members. Each official must complete a Report of
Official and Agreement to Serve (NCUA 4012) which is to be submitted with this investigation report.






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B. CHARACTER AND FITNESS OF SUBSCRIBERS
Type of print the list of the subscribers who have signed the organization certificate (7 not more than 10
persons). Names should be IDENTICAL to signatures on the Organization Certificate (NCUA 4008) Each
subscriber listed below has subscribed to at least one share in accordance with Section 103 of the
Federal Credit Union Act:






Name:

Name:

Address:

Address:

Occupation:

Occupation:

Years of membership:

Years of membership:

Name:

Name:

Address:

Address:

Occupation:

Occupation:

Years of membership:

Years of membership:

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Name:

Name:

Address:

Address:

Occupation:

Occupation:

Years of membership:

Years of membership:

Name:

Name:

Address:

Address:

Occupation:

Occupation:

Years of membership:

Years of membership:

Name:

Name:

Address:

Address:

Occupation:

Occupation:

Years of membership:

Years of membership:

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