Form NCUA 4015 NCUA 4015 Application for Field of Membership Amendment

APPLICATION FOR FIELD OF MEMBERSHIP AMENDMENT
NCUA FORM 4015
USE FOR MULTIPLE COMMON BOND EXPANSION FOR GROUPS OF
3,000 OR MORE PERSONS
Attach a separate application for each group included in your request for expansion.
The application must be complete or it will be returned unprocessed.
1. NameRIFUHGLWXQLRQ
$ddress of credit union:

Telephone Number:

Charter Number:

2. Name and address of group:

Telephone Number:
If the group is an association, include a copy of the association’s
Charter/Bylaws or other equivalent organizational documentation.
3. Provide the proposed field of membership wording. Use the example wording found
in NCUA’s Chartering and Field of Membership Manual, Chapter 2, Section IV.A.2.

NCUA 4015

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4. How many primary potential members (excluding immediate family and household
members) are in the group:
5. (a) What is the distance between the group’s location and your credit union’s nearest
service facility1 to which the group has access (Reference Chapter 2, Section
IV.A.1):
(b) What is the address of this service facility:
(c) Describe the service area2 primarily served by the above service facility:

6. Is the group in the field of membership of any other credit union? File Typeapplication/pdfFile Title2003-NCUA_4015 FEB25wAuthorJoeOFile Modified2013-11-21File Created2003-05-09