Form 7300/08 Contact Information Form

OMB Number 3064-0192

Expiration Date: 8/31/2016

PRIVACY ACT STATEMENT

The Federal Deposit Insurance Act (12 U.S.C. §§1819, 1821, and 1823) and authorizes the collection of this information.  The FDIC will use this information in the marketing of assets, to identify qualified potential purchasers and to solicit bids for assets.  Submitting this information to the FDIC is voluntary.  Failure to submit all of the information requested could result in your inability to bid on or purchase assets held by the FDIC.  The information provided by individuals is protected by the Privacy Act, 5 USC §552a.  The information may be furnished to third parties as authorized by law and in accordance with any of the other routine uses described in the FDIC Potential Bidders List (FDIC-30-64-0019) System of Records.  A complete copy of this System of Records is available at http://www.fdic.gov/regulations/laws/rules/2000-4050.html#fdic200030--64--0019.  If you have questions or concerns about the collection or use of the information, you may contact the FDIC’s Chief Privacy Officer at [email protected].

ESTIMATED REPORTING BURDEN

Public reporting burden for this collection is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Paperwork Reduction Act, Legal Division, FDIC, Washington, D.C. 20429; and to the Office of Management and Budget, Paperwork Reduction Project (3064-0135), Washington, D.C. 20503. Respondents need not respond to this request for information unless it displays a currently valid OMB Control Number. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Number 3064-0192

Expiration Date: 8/31/2016

Federal Deposit Insurance Corporation

CONTACT INFORMATION FORM

INSTRUCTIONS: The information requested by this form is required to determine the type of Assets a Prospective Bidder is interested in and to facilitate communication with the Prospective Bidder. The information required by this Form may be submitted in a separate typed or printed document, including by electronic mail. Print clearly.

1. Name of Prospective Bidder (The name of the firm/individual)				2. Preferred Mailing Address
     				     
3. Physical Address (if different)
     
4. Corporate Parent or Guarantor Name				4a. Phone Number		4b. Fax Number
     				     		     
4c. Street Address	4d. City, State ZIP Code			4e. Email Address
     	     			     
5. General Partner (s) Name (If Prospective Bidder is a partnership) or Manager (If Prospective Bidder is a limited liability company).
                 
5a. Phone Number				5b. Fax Number
     				     
5c. Street Address	5d. City, State ZIP Code			5e. Email Address
     	     			     
6. Contacts (Please provide a primary and secondary contact, no more than two). (The individual to be contacted when updating the Purchaser Eligibility Certification, to represent the firm, to receive sale notifications, to discuss other questions regarding qualifications, their title, address, if different from above, and phone, and e-mail address).
6a. Primary Contact Name				6b. Phone Number		6c. Fax Number
     				     		     
6d. Street Address	6e. City, State ZIP Code			6f. Email Address
     	     			     
6g. Secondary Contact Name				6h. Phone Number		6i. Fax Number
     				     		     
6j. Street Address	6k. City, State ZIP Code			6l. Email Address
     	     			     
7. Product Types Offered (Check the applicable box(es) for the type of product that you (or your organization) are interested in bidding on.) The assets available for sale may vary significantly at any given time and are dependent on the assets held by the FDIC as Receiver for financial institutions.
Agency Securities		Private-Label MBS/Other Asset- Backed Securities			CMO’s/CDO’s
Corporate Bonds/Notes		High-Yield Bonds			Interest-Only (IO)/Principal Only (PO)
Limited Partnership		Municipal Securities			Common Stock/Preferred Stock
U.S. Treasuries		Other Sovereign Debt			Syndicated Loans
Structured Transactions*		Trust Preferred Securities (TruPS)			Other Financial Assets**
*Structured Transactions. The sale of equity interests in newly formed special-purpose limited liability companies to which the FDIC as Receiver for one or more failed financial institutions has transferred primarily nonperforming residential, commercial or construction real estate mortgage loans and related assets. Other Financial Assets. CRA-Related Assets, Credit Card Receivables, Interest Rate Swaps, Other Derivative Products, Loan Production Platforms, Residuals, Servicing Rights, etc. Indicate below:      
8. The FDIC welcomes and strongly encourages participation of minority- or women-owned businesses (“MWO Businesses”) in FDIC structured transactions and other asset disposition transactions. Entities that qualify as MWO Businesses1 will have the opportunity to disclose such information during the pre-qualification and qualification process so that the FDIC can examine the level of MWO Business interest in future structured transactions and other asset disposition opportunities and identify additional MWO Business outreach activities to support diversity of participation. Therefore, the FDIC would appreciate MWO Business assistance in completing the survey below relating to MWO Business status and checking all appropriate responses. Please understand that disclosure of information concerning MWO Business status is for FDIC informational purposes only.
Are you a minority, or is your entity, minority-owned?							Yes No
Race/Ethnicity			American Indian or Alaska Native
			Asian
			Black or African American
			Native Hawaiian or Other Pacific Island
			Hispanic or Latino
Are you a woman, or is your entity, women-owned?							Yes No
The foregoing information was submitted by       (Type or Print name of individual completing this Form) as of,      20      (date on which Form is provided).

1 MWO Businesses are at least 51% owned and controlled, through day-to-day management by persons of one or more of the following groups: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, Hispanic or Latino and/or Women. ^? MWO Businesses are at least 51% owned and controlled, through day-to-day management by persons of one or more of the following groups: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, Hispanic or Latino and/or Women.

FDIC 7300/08 (8-13) Page 3