NCUA 4000 Conversion of State Charter to Federal Charter

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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ANY ADDITIONAL COMMENTS OR INFORMATION THAT IS DEEMED PERTINENT
OR HELPFUL IN GIVING CONSIDERATION TO THIS APPLICATION SHOULD BE
INCLUDED AS AN ATTACHMENT.

The undersigned certifies that to the best of his/her knowledge and belief the
above information is true and correct.
I

do

do not recommend that a charter be granted to this group.

Signature ____________________________________ , Organizer
Organizer's Address:

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FORM 4000 INSTRUCTIONS
A. INFORMATION FOR CHARTERS AND BYLAWS
The subscriber should select a name for the proposed credit union. It is the
responsibility of the federal credit union organizers to ensure that the proposed
federal credit union name does not constitute an infringement on the name of any
corporation in its trade area. The last three words in the name must be "Federal
Credit Union." Since the name selected should not duplicate exactly the name of
an existing credit union, item 1 provides space for a second choice.
The territory of operations of a Federal credit union is described in the field of
membership, item 5. The principal office of the credit union will usually be
maintained at a location described in the field of membership.
The proposed field of membership should be defined so clearly that it leaves no
room for any doubt as to whom the credit union is to serve or the area which it is
to operate. Corporations and other organizations referred to in the definition of
the field of membership should be designated by the exact names rather than by
some local or popular contraction of these names. Any segment of a larger
organization should be identified with the parent. The field of membership for
each type of common bond and samples are discussed in detail in Chapter 2 of
the "Chartering and Field of Membership Manual."
With the guidance of the organizer, the subscribers to the Organization Certificate
decide on the number of directors and credit committee members. The board and
credit committee must be composed of an odd number of members. The
supervisory committee is appointed by the board of directors.
B. CHARACTER AND FITNESS OF SUBSCRIBERS
The names and address of the subscribers should be recorded legibly and
completely in item 7 of this report. It is from this information that the National
Credit Union Administration prepares Section 3 of the charter. The names of the
subscribers must be IDENTICAL to their signatures on the Organization
Certificate.
C. SUBMITTAL OF CHARTER APPLICATION
In addition to this Investigation Report, the following should be submitted to the
appropriate regional director of NCUA:
1. Application to Convert, NCUA 4401 – one original;
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2. Written evidence regarding whether the state regulator is in agreement with
the conversion proposal;
3. Application and Agreements for Insurance of Accounts, NCUA 9500 - one
original;
4. Certificate of Resolution, NCUA 9501 - one original;
5. Organization Certificate, NCUA 4008 - one notarized original. At least seven,
but no more than ten persons, must sign the organization certificate. The person
administering the oath must not be one of the subscribers. The oath on the
organization certificate must be executed and show the notary's seal and date the
commission expires as required by State law;
6. Report of Official and Agreement to Serve, NCUA 4012 – one original for each
board member, credit committee member, and supervisory committee member;
7. Most current financial report and delinquent loan schedule; and
8. Business Plan - refer to Chapter 1 of the Chartering and Field of Membership
Manual for a discussion of the components of an acceptable business plan.

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