Form 3064-0001 Interagency Charter and Federal Deposit Insurance Applic

OMB No. for FDIC 3064-0001
OMB No. for OCC 1557-0014
OMB No. for OTS 1550-0005
Expiration Date: 08/31/2019

INTERAGENCY CHARTER AND FEDERAL DEPOSIT INSURANCE APPLICATION
Public reporting burden for this collection of i nformation is estimated to average 250 hours per response (125
hours for t he chart er appl ication and 125 hours for t he i nsurance appl ication), i ncluding t he t ime to review
instructions, search, and to review and complete the information col lection. Send com ments regardi ng t his
burden est imate or any ot her aspect of t his col lection of i nformation, i ncluding suggest ions for reduci ng t his
burden to: Offi ce of t he Execut ive Secret ary, Federal Deposi t Insurance C orporation, 550 17t h St reet, NW ,
Washington, DC 20429; Li censing Pol icy and Sy stems Di vision, C omptroller of t he C urrency, 250 E St reet,
S.W., Washington, DC 20219; or Office of Exam ination Policy, Office of Thri ft Supervision, 1700 G St reet,
N.W., W ashington, DC 20552; and t o t he Offi ce of Management and B udget, Paperwork R eduction Project,
Washington, DC 20503.
An organi zation or a person i s not requi red to respond to a col lection of i nformation unl ess i t di splays a
currently valid OMB control number.

GENERAL INFORMATION AND INSTRUCTIONS
Preparation and Use
This application is used to effect a transaction under:
•
•
•
•

Sections 5 and 6 of the Federal Deposit Insurance Act (FDIA), as amended (12 U.S.C.
1815, 1816), for federal deposit insurance.
Section 5(e) of the Home Owners’ Loan Act (HOLA), as amended (12 U.S.C.
1464(e)), for a federal savings association charter.
The National Bank Act, as amended (12 U.S.C. 21 et seq.), for a national bank charter.
The state law for applying for state depository charters, as approved by state
regulatory authorities.

All questions must be answered with complete and accurate information that is subject to
verification. If the answer is "none," "not applicable," or "unknown," so state. Answers of
"unknown" should be explained.
The questions in the application are not intended to limit the Applicant's presentation nor are
the questions intended to duplicate information supplied on another form or in an exhibit. For
such information, a cross reference to the information is acceptable. Any such cross-reference
must be made to a specific cite or location in the documents, so the information can be
located easily. Supporting information for all relevant factors, setting forth the basis for
Applicant's conclusions, should accompany the application. The regulatory agency may
request additional information.

This application form collects information that the regulatory agencies will need to evaluate
a charter or insurance application. While most of the information will be available when the
organizers submit the application, some information will not be available at that time. Each
agency has specific purposes and different timing requirements in collecting some of this
information; for example, receipt of the organizers’ draft policies. For any question about
when to submit a specific item, organizers should contact the appropriate regulatory agencies
to discuss the specific timing for submission.
The regulatory agency must consider the applicable statutory requirements set forth in the
preceding provisions, as well as applicable regulatory requirements, when acting on this
application. For additional information regarding these statutory and regulatory requirements,
as well as processing procedures and guidelines and any supplemental information that may be
required, please refer to the appropriate regulatory agency's procedural guidelines [i.e.,
Comptroller’s Corporate Manual, the FDIC's Rules and Regulations (12 C.F.R. 303) and
Statement of Policy on “Applications for Deposit Insurance”, the OTS' Applications Processing
Handbook, or the application guidelines for the state in which the Applicant seeks a state
charter]. The Applicant may contact the agency
directly for specific instruction or visit their websites at www.fdic.gov, www.occ.treas.gov,
www.ots.treas.gov, and www.csbs.org (through “Links” to each state banking department).
Notice of Publication
The Applicant must publish notice of the proposed organization in a newspaper of general
circulation in the community or communities in which the proposed financial institution will
be located. Contact the appropriate regulatory agency for the specific requirements of the
notice of publication.
Electronic Submission
In addition to an original application and the appropriate number of signed copies, the
regulatory agencies would like to have an electronic copy of the information in the
application, especially of the business plan’s financial projections. Submission of an
electronic copy is voluntary. It will be used only for internal review and processing and will
not be released to the public. The electronic copy may be provided on a computer diskette,
using common word processing and spreadsheet software. For E-mail submissions, contact
the appropriate regulatory agency for instructions and information about secure transmission
of confidential material.
Confidentiality
Any Applicant desiring confidential treatment of specific portions of the application must
submit a request in writing with the application. The request must discuss the justification
for the requested treatment. The Applicant's reasons for requesting confidentiality should
specifically demonstrate the harm (for example, loss of competitive position, invasion of
privacy) that would result from public release of information (5 U.S.C. 552 or relevant state
law). Information for which confidential treatment is requested should be: (1) specifically

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identified in the public portion of the application (by reference to the confidential section);
(2) separately bound; and (3) labeled "Confidential." The Applicant should follow the same
procedure when requesting confidential treatment for the subsequent filing of supplemental
information to the application.
The Applicant should contact the appropriate regulatory agency for specific instructions
regarding requests for confidential treatment. The appropriate regulatory agency will
determine whether the information will be treated as confidential and will advise the
Applicant of any decision to publicly release information labeled as "Confidential."

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INTERAGENCY CHARTER AND FEDERAL DEPOSIT INSURANCE APPLICATION
(Check all appropriate boxes.)
Type of Charter
National Bank
State Bank
Federal Savings Bank or Association
State Savings Association
Other
Special Focus
Community Development
Cash Management
Trust
Bankers’ Bank
Credit Card:
CEBA
Other
For OCC:

Standard

Non-CEBA
Expedited

Chartering Agency
Comptroller of the Currency
Office of Thrift Supervision
State
Insurance Fund
Bank Insurance Fund
Savings Association Insurance Fund
Type of Insurance Application
De Novo
Operating Noninsured Institution
Other
Federal Reserve Status
Member Bank
Nonmember Bank

Proposed Depository Institution (institution)

Name
Street
City

State

ZIP Code

Holding Company Identifying Information (if applicable)

Name
Street
City

State

ZIP Code

State

ZIP Code

Contact Person

Name
Street
City

INTERAGENCY CHARTER AND FEDERAL DEPOSIT INSURANCE APPLICATION

1.

2.

Overview
(a)

Provide a brief overview of the application. The overview should describe the
institution’s business and any special market niche, including the products,
market, services, and any nontraditional activities.

(b)

Describe any issues about the permissibility of the proposal with regard to
applicable state or federal laws or regulations. Identify any regulatory waiver
requests and provide adequate justification.

(c)

List and provide a copy of all applications filed in conjunction with this proposal,
such as applications for holding company, trust powers, branch offices, service
corporations, and other subsidiaries.

(d)

When available, provide a copy of all public or private offering materials and the
proposed form of stock certificate, including any required restrictive legends.

(e)

Provide a copy of the proposed articles of association, articles of incorporation, or
charter, and proposed bylaws.

(f)

Provide a copy of the business plan. The business plan should address, at a
minimum, the topics contained in the appropriate regulatory agency’s Business
Plan Guidelines.

Management
(a)

Provide a list of the organizers, proposed directors, senior executive officers, and
any individual, or group of proposed shareholders acting in concert, that will own
or control 10 percent or more of the institution’s stock. For each person listed,
attach an Interagency Biographical and Financial Report, a fingerprint card, and
indicate all positions and offices currently held or to be held with the institution’s
holding company and its affiliates, if applicable. Include the signed “Oath of
Director” for each proposed director. For an OTS filing, provide a RB 20a
Certification for each person listed.

(b)

Describe each proposed director’s qualifications and experience to serve and
oversee management’s implementation of the business plan. Describe the extent,
if any, to which directors or major stockholders are or will be involved in the dayto-day management of the institution. Also list the forms of compensation, if any.

(c)

Provide a list of board committees and members.

(d)

Describe any plans to provide ongoing director education or training.

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(e)

Describe each proposed senior executive officer’s duties and responsibilities and
qualifications and experience to serve in his/her position. If a person has not yet
been selected for a key position, list the criteria that will be required in the
selection process. Discuss the proposed terms of employment, including
compensation and benefits, and attach a copy of all pertinent documents,
including an employment contract or compensation arrangement. Provide the
aggregate compensation of all officers.

(f)

Describe any potential management interlocking relationships (12 U.S.C.
1467a(h)(2), 3201-3208, or applicable state law) that could occur with the
establishment or ownership of the institution. Include a discussion of the
permissibility of the interlock with regard to relevant law and regulations or
include a request for an exemption.

(g)

Describe any potential conflicts of interest.

(h)

Describe any transaction, contract, professional fees, or any other type of business
relationship involving the institution, the holding company, and its affiliates (if
applicable), and any organizer, director, senior executive officer, shareholder
owning or controlling 10 percent or more, and other insiders. Include
professional services or goods with respect to organizational expenses and bank
premises and fixed asset transactions. (Transactions between affiliates of the
holding company that do not involve the institution need not be described.)

(i)

1)

State whether the business relationship is made in the ordinary course of
business, is made on substantially the same terms as those prevailing at the
time for comparable transactions with non-insiders, and does not present
more than the normal risk of such transaction or present other unfavorable
features.

2)

Specify those organizers that approved each transaction and whether the
transaction was disclosed to proposed directors and prospective
shareholders.

3)

Provide all relevant documentation, including contracts, independent
appraisals, market valuations, and comparisons.

Describe all stock benefit plans of the institution and holding company, including
stock options, stock warrants, and other similar stock-based compensation plans,
for senior executive officers, organizers, directors, and other insiders. Include in
the description:
1)

The duration limits.

2)

The vesting requirements.

3)

Transferability restrictions.
3

4)

Exercise price requirements.

5)

Rights upon termination.

6)

Any “exercise or forfeiture” clause.

7)

Number of shares to be issued or covered by the plans.

Provide a list of participants, allocation of benefits to each participant, and a copy
of each proposed plan. (Plans must conform to applicable regulatory guidelines.)

3.

.

Capital
(a)

For each class of stock, provide the number of authorized shares, the number of
shares to be issued, par value, voting rights, convertibility features, liquidation
rights, and the projected sales price per share. Indicate the amount of net
proceeds to be allocated to common stock, paid-in surplus, and other capital
segregations.

(b)

Describe any noncash contributions to capital, and provide supporting documents
for assigned values, including an independent evaluation or appraisal.

(c)

Discuss the adequacy of the proposed capital structure relative to internal and
external risks, planned operational and financial assumptions, including
technology, branching, and projected organization and operating expenses.
Present a thorough justification to support the proposed capital, including any offbalance-sheet activities contemplated. Describe any plans for the payment of
dividends.

(d)

List all known subscribers to stock. For organizers, directors, 10 percent
shareholders, senior executive officers, and other insiders, include the number of
shares and anticipated investment and the amount of direct and indirect
borrowings to finance the investment. Discuss how any debt will be serviced.

(e)

List recipients and amounts of any fees, commissions, or other considerations in
connection with the sale of stock.

(f)

Indicate whether the institution plans to file for S Corporation tax status.

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4.

Convenience and Needs of the Community
NOTE:

This information must be consistent with the proposed business plan.

(a) Market

(b)

Characteristics

1)

Define the intended geographical market area(s). Include a map of the
market area, pinpointing the location of proposed bank’s offices and
offices of competing depository institutions.

2)

Describe the competitive factors the institution faces in the proposed
market and how the institution will address the convenience and needs of
that market to maintain its long-term viability.

3)

Discuss the economic environment and the need for the institution in
terms of population trends, income, and industry and housing patterns.

Community Reinvestment Act (CRA) Plan1
NOTE: The CRA Plan must be bound separately.
2

1)

Identify the assessment area(s) according to the CRA regulations.

2)

Summarize the performance context for the institution based on the factors
3
discussed in the CRA regulations.

3)

Summarize the credit needs of the institution’s proposed assessment
area(s).

4)

Identify the CRA evaluation test4 under which the institution proposes to
be assessed.

5)

Discuss the institution’s programs, products, and activities that will help
meet the existing or anticipated needs of its community(ies) under the
applicable criteria of the CRA regulation, including the needs of low- and
moderate-income geographies and individuals.

1

See applicable state requirements.
See 12 C.F.R. 25.41, 345.41, 563.41.
3
See 12 C.F.R. 25.21(b), 345.21(b), 563e.21(b).
4
See 12 C.F.R. 25.21(a); 345.21(a); 563e.21(a).
2

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5.

5

Premises and Fixed Assets
(a)

Provide a physical description for permanent premises and discuss whether they
will be publicly and handicapped accessible. Indicate the level and type of
property insurance to be carried.

(b)

If the permanent premises are to be purchased, provide name of seller, purchase
price, cost and description of necessary repairs and alterations, and annual
depreciation. If the premises are to be constructed, provide the name of the seller,
the cost of the land, and the construction costs. Indicate the percentage of the
building that will be occupied by the bank. Provide a copy of the appraisal.

(c)

If the permanent premises are to be leased, provide name of owner, terms of the
lease, and cost and description of leasehold improvements. Provide a copy of the
proposed lease when available.

(d)

If temporary quarters are planned, provide a description of interim facility, length
of use, lease terms, and other associated commitments and costs.

(e)

State whether proposed premises and fixed asset expenditures conform to
applicable statutory limitations.

(f)

Outline the security program that will be developed and implemented, including
the security devices.5

(g)

Discuss any significant effect the proposal will have on the quality of the human
environment. Include in the discussion changes in air and/or water quality, noise
levels, energy consumption, congestion of population, solid waste disposal, or
environmental integrity of private land within the meaning of the National
Environmental Policy Act, 42 U.S.C. 4321, et seq.

(h)

Describe any plan to establish branches or relocate the main office within the first
three years. Any acquisition or operating expenses should be reflected in the
financial projections.

(j)

Indicate if the establishment of the proposed main office and/or any branch
site may affect any district, site, building, structure, or object listed in, or
eligible for listing in, the National Register of Historic Places pursuant to the
National Historic Preservation Act, 16 U.S.C. 470f. (See the Advisory
Council
on Historic Preservation at www.achp.gov for the Act and implementing
regulations.) Specify how such determination was made:

See 12 C.F.R. 21, 326, 568.

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1)

Consultation with the State Historic Preservation Officer (SHPO)
and/or Tribal Historic Preservation Officer (THPO) (when tribal lands
or historic properties of significance to a tribe are involved).
2)
Reviewed National Register of Historic Places (see
www.cr.nps.gov/nr).
3)
Applied National Register criteria to unlisted properties.6
4)
Reviewed historical records.
5)
Contact with preservation organizations.
6) Other
(describe).
As appropriate, provide a copy of any documentation of consultation with the
SHPO and/or THPO. You are reminded that if a historic property may be
affected, no site preparation, demolition, alterations, construction or
renovation may occur without the appropriate regulatory agency’s
authorization.

6.

6

Information Systems
(a)

State whether the institution plans to market its products and services (the
ability to do transactions or account maintenance) via electronic means. If
yes, specifically state the products and services that will be offered via
electronic banking or the Internet.

(b)

Outline the proposed or existing information systems architecture and any
proposed changes or upgrades. The information should describe how: (1) the
information system will work within existing technology; (2) the information
system is suitable to the type of business in which the institution will engage;
(3) the security hardware, software, and procedures will be sufficient to
protect the institution from unauthorized tampering or access; and (4) the
organizers and directors will allocate sufficient resources to the entire
technology plan.

(c)

Provide lists or descriptions of the primary systems and flowcharts of the
general processes related to the products and services. The level of detail in
these system descriptions should be sufficient to enable verification of the
cost projections in the pro formas.

(d)

Estimate the start-up budget for the information systems related to the
products and services and the expected annual operating and maintenance
costs (including telecommunications, hardware, software, and personnel).

See 36 C.F.R. 60.4.
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7.

(e)

Describe the physical and logical components of security. Describe the
security system and discuss the technologies used and key elements for the
security controls, internal controls, and audit procedures. Discuss the types of
independent testing7 the institution will conduct to ensure the integrity of the
system and its controls.

(f)

Describe the information security program that will be in place to comply
with the “Interagency Guidelines Establishing Standards for Safeguarding
Customer Information.”8

Other Information
(a)

List activities and functions, including data processing, that will be outsourced
to third parties, identifying the parties and noting any affiliations. Describe all
terms and conditions of the vendor management activities and provide a copy
of the proposed agreement when available. Describe the due diligence
conducted and the planned oversight and management program of the
vendors’ or service providers’ relationships (for general vendor management
guidance, see the Appendix of the FFIEC’s guidance, Risk Management of
Outsourced Technology Services).

(b)

List all planned expenses related to the organization of the institution and
include the name of recipient, type of professional service or goods, and
amount. Describe how organization expenses will be paid.

(c)

Provide evidence that the institution will obtain sufficient fidelity coverage on
its officers and employees to conform with generally accepted banking
practices.

(d)

If applicable, list names and addresses of all correspondent depository
institutions that have been established or are planned.

(e)

Provide a copy of management’s policies for loans, investments, liquidity,
funds management, interest rate risk, and other relevant policies. Provide a
copy of the Bank Secrecy Act program. Contact the appropriate regulatory
agencies to discuss the specific timing for submission.

(f)

For Federal Savings Banks or Associations, include information addressing
the proposed institution’s compliance with qualified thrift lender
requirements.

7

Independent tests should cover general and environmental controls as well as audit, monitoring, and balancing controls.
Independent testing will provide an objective opinion on the adequacy of these controls.
8
See 15 U.S.C. 6801, 6805(b); 12 C.F.R. 30; 308 and 364; 568 and 570.
8

(g)

If the institution is, or will be, affiliated with a company engaged in insurance
activities that are subject to supervision by a state insurance regulator,
provide:
1)
2)
3)

The name of insurance company.
A description of the insurance activity that the company is engaged in
and has plans to conduct.
A list of each state and the lines of business in that state in which the
company holds, or will hold, an insurance license. Indicate the state
where the company holds a resident license or charter, as applicable.

9

OCC CERTIFICATION
We, the organizers, certify that the information contained in this application has been examined
carefully and is true, correct, and complete, and is current as of the date of this submission. We
also certify that any misrepresentations or omissions of material facts with respect to this
application, any attachments to it, and any other documents or information provided in
connection with the application for the organization of the proposed financial institution and
federal deposit insurance may be grounds for denial or revocation of the charter and/or
insurance, or grounds for an objection to the undersigned as proposed director(s) or officer(s) of
the proposed financial institution, and may subject the undersigned to other legal sanctions,
including the criminal sanctions provided for in 18 U.S.C. 1001, 1007, and 1014. We request
that examiners be assigned to make any investigations necessary.
We acknowledge that approval of this application is in the discretion of the appropriate federal
banking agency or agencies. Actions or communications, whether oral, written, or electronic, by
an agency or its employees in connection with this filing, including approval of the application if
granted, do not constitute a contract, either express or implied, or any other obligation binding
upon the agency, other federal banking agencies, the United States, any other agency or entity of
the United States, or any officer or employee of the United States. Such actions or
communications will not affect the ability of any federal banking agency to exercise its
supervisory, regulatory, or examination powers under applicable law and regulations. We
further acknowledge that the foregoing may not be waived or modified by any employee or agent
of a federal banking agency or of the United States.
Signature

Date

Typed Name

10

FDIC CERTIFICATION
We, the organizers, certify that the information contained in this application has been
examined carefully and is true, correct, and complete, and is current as of the date of this
submission. We also certify that any misrepresentations or omissions of material facts with
respect to this application, any attachments to it, and any other documents or information
provided in connection with the application for the organization of the proposed financial
institution and federal deposit insurance may be grounds for denial or revocation of the
charter and/or insurance, or grounds for an objection to the undersigned as proposed
director(s) or officer(s) of the proposed financial institution, and may subject the undersigned
to other legal sanctions, including the criminal sanctions provided for in 18 U.S.C. 1001,
1007, and 1014. We request that examiners be assigned to make any investigations
necessary.
We acknowledge that approval of this application is in the discretion of the appropriate
federal banking agency or agencies. Actions or communications, whether oral, written, or
electronic, by an agency or its employees in connection with this filing, including approval of
the application if granted, do not constitute a contract, either express or implied, or any other
obligation binding upon the agency, other federal banking agencies, the United States, any
other agency or entity of the United States, or any officer or employee of the United States.
Such actions or communications will not affect the ability of any federal banking agency to
exercise its supervisory, regulatory, or examination powers under applicable law and
regulations. We further acknowledge that the foregoing may not be waived or modified by
any employee or agent of a federal banking agency or of the United States.
It is understood that the Board of Directors of the Federal Deposit Insurance Corporation
(Corporation), in applying the factors set out in federal statutes, will consider the application
only with respect to the general character or type of business stated and that the depository
institution will not engage in any other business without the prior written consent of the
Corporation.
It is further understood that federal deposit insurance will not become effective (a) until the
proposed depository institution has been incorporated and authorized to engage in the
business of receiving deposits, (b) until the board of directors of the depository institution
has adopted a resolution ratifying and confirming the action of the incorporators in making
this application with supporting information, (c) until the depository institution has fulfilled
such requirements, if any, as the Corporation may impose as a condition of its approval of

11

this application, and (d) until the depository institution has been notified that its membership
in the Corporation has been approved.
Signature

Date

Typed Name

12

OTS CERTIFICATION
We, the organizers, certify that:
(i)
The information contained in this application has been examined carefully and is
true, correct, and complete, and is current as of the date of this submission.
(ii)
Any misrepresentations or omissions of material facts with respect to this
application, any attachments to it, and any other documents or information provided in
connection with the application for the organization of the proposed financial institution
and federal deposit insurance may be grounds for denial or revocation of the charter
and/or insurance, or grounds for an objection to the undersigned as proposed director(s)
or officer(s) of the proposed association, and may subject the undersigned to other legal
sanctions, including the criminal sanctions provided for in 18 U.S.C. 1001, 1007, and
1014.
(iii) The undersigned will not represent themselves as authorized to organize such
association until this application is approved and, upon notification that the application
has been approved, they will proceed only in accordance with the provisions of the Home
Owners’ Loan Act of 1933, as amended, and with rules and regulations made thereunder.
(iv)
The undersigned are not acting in this application as representative or on behalf of
any person, partnership, association, or corporation undisclosed to the Office of Thrift
Supervision.
(v)
No charge or expense incurred in connection with the organization of the
association shall be charged to the association.
(vi)
No funds or money will be accepted for deposit or collected on account by or for
the association until this application is approved and its organization has been completed.
(vii) For mutual associations, an organizational committee will be created promptly
upon approval of this application, and the committee members will serve as temporary
officers of the association until officers are elected by the members of the association.
We request that examiners be assigned to make any investigations necessary.
We also acknowledge that approval of this application is in the discretion of the Office of
Thrift Supervision. Actions or communications, whether oral, written, or electronic, by
the Office of Thrift Supervision or its employees in connection with this filing, including
approval of the application if granted, do not constitute a contract, either express or
implied, or any other obligation binding upon the Office of Thrift Supervision, other
federal banking agencies, the United States, any other agency or entity of the United
States, or any officer or employee of the United States. Such actions or communications
will not affect the ability of any federal banking agency to exercise its supervisory,
regulatory, or examination powers under applicable law and regulations. We further

13

acknowledge that the foregoing may not be waived or modified by any employee or
agent of a federal banking agency or of the United States.
Signature

Date

Typed Name

14

EXHIBITS (check all that apply)
Business
Plan
Financial
CRA

Projections

Plan

Articles of Association, Articles of Incorporation, or Charter
Bylaws
Oath of Director
Interagency Biographical and Financial Reports
Fingerprint cards (appropriate regulatory agency)
Publication Certification/Affidavit/Notice of Publication
Copies of contracts/agreements
Em
ployment/compensation
Service
providers
Other
Stock Benefit Plans
Economic survey or market feasibility study
Market Area Map
Waiver request, specify:
Offering

Materials

Proposed stock certificate
Corporate or holding company audited statements or financial reports
OCC/OTS/state filing fee
Copy of policies, specify:
OTS ONLY:
RB 20a Certification

15

Oath of the Bank Director
Bank Name
State of
County of

Date

I, the undersigned, a (proposed) director of the above-named bank do solemnly swear
(affirm) that:
As a director, I have a legal responsibility and a fiduciary duty to shareholders to
administer the depository institution’s affairs faithfully and to oversee its management.
In carrying out my duties and responsibilities, I shall exercise reasonable care and place
the interests of the depository institution before my own interests. I shall fulfill my duties
of loyalty and care to the above-named depository institution.
I shall, commensurate with my duties, diligently and honestly administer the affairs of the
depository institution, and I shall not knowingly violate, or willingly permit to be violated, any
applicable statute or regulation. I shall ensure that I learn of changes in statutes, regulations, and
policies of the Office of Comptroller of the Currency, the Federal Deposit Insurance
Corporation, or any state to whose jurisdiction my association is subject, which affect my duties,
responsibilities, or obligations as a director and affiliated person of the association.
I am the owner, in good faith and in my own right, of the number of shares of stock that
the law requires. I have either subscribed for this stock or it is issued and outstanding, and it is
not hypothecated, or in any way pledged, as security for any loan or debt.
I shall attend meetings of the board of directors and participate fully on all committees of
the board to which I am appointed.
Signature
Typed Name
Mailing Address
City

State

ZIP Code

Notary’s Affirmation
Sworn to before me and subscribed in my presence, this

day of

Notary Public
My Commission Expires _____________________________

16

, _________.

Oath of Savings Association Director
Name of Savings Association
City

State.

County.

I, the undersigned, a [proposed] director of the above-named savings association, do solemnly
swear (affirm) as follows:
1.
I acknowledge that service as a director of a federally insured savings association is an
important undertaking that carries with it significant duties and responsibilities. I have read and
understand the OTS Directors’ Responsibilities Guide describing the duties of directors and
officers of savings association.
2.
As a director of the above-named savings association, I have a legal responsibility and a
fiduciary duty to its shareholders and creditors and to the applicable federal deposit insurance
funds to administer the savings association’s affairs faithfully and to oversee its management. In
carrying out my duties and responsibilities, I shall exercise reasonable care and place the
interests of the savings association before my own interests. I shall fulfill my duties of loyalty
and care to the above-named savings association.
3.
I shall diligently and honestly administer the affairs of the savings association, and I shall
not knowingly violate, or willingly permit to be violated, any applicable statute or regulation. I
shall ensure that I learn of changes in statutes, regulations, and policies of the Office of Thrift
Supervision and the Federal Deposit Insurance Corporation or any state to whose jurisdiction my
association is subject, which affect my duties, responsibilities, or obligations as a director and
affiliated person of the savings association.
4.
I shall attend meetings of the board of directors and participate fully on all committees of
the board to which I am appointed.
Signature
Type Name
Mailing Address
City
Date

State

ZIP Code

Notary’s Affirmation
Sworn to before me and subscribed in my presence this ____ day of ___________, _______.
Notary Public ______________________________________________
My Commission Expires ______________________________________

17

Business Plan Guidelines
Preparation and Use
The business plan should be an integral part of the management and oversight of a financial institution
(institution). It should establish the institution’s goals and objectives. It is a written summary of how the
business will organize its resources to meet its goals and how the institution will measure progress.
The business plan should be a comprehensive plan, which is the result of in-depth planning by the institution’s
organizers and management. It should realistically forecast market demand, customer base, competition, and
economic conditions. The plan must reflect sound banking principles and demonstrate realistic assessment of
risk in light of economic and competitive conditions in the market to be served. An institution with a special
purpose or focus (for example, credit card, trust only, cash management, or bankers’ bank) should address this
special or unique feature in detail in the appropriate sections of the plan.
The business plan should cover three years and provide detailed explanations of actions that are proposed to
accomplish the primary functions of the institution. The description should provide enough detail to
demonstrate that the institution has a reasonable chance for success, will operate in a safe and sound manner,
and will have adequate capital to support the risk profile.
For any institution with an Internet or alternative electronic delivery channel, the plan should contain a clear
and detailed definition of the market the institution plans to serve and the products and services it will provide
through electronic channels. Because the Internet has a potential global market and can reach anyone with
Internet access, the selected information on market area and products and services is essential. The marketing
plan should explain how the institution would achieve brand recognition.

Confidentiality
Any Applicant desiring confidential treatment of specific portions of the plan and projections must
submit the request in writing. The request must discuss the justification for the requested treatment.
The Applicant’s reasons for requesting confidentiality should specifically demonstrate the harm (for
example, loss of its competitive position, invasion of privacy) that would result from public release of
information (5 U.S.C. 552 or relevant state law). Information for which confidential treatment is
requested should be: (1) specifically identified in the public portion of the application (by reference to
the confidential section); (2) separately bound; and (3) labeled "Confidential." The Applicant should
follow the same procedure when requesting confidential treatment for the subsequent filing of
supplemental information to the plan.
The Applicant should contact the appropriate regulatory agency for specific instructions regarding requests for
confidential treatment. The appropriate regulatory agency will determine whether the information will be
treated as confidential and will advise the Applicant of any decision to publicly release information labeled as
"Confidential."

18

BUSINESS PLAN
I.

Table of Contents
II. Executive Summary
Describe the highlights of the plan.

III.

IV.

Description of Business
A.

Describe the institution’s business and any special market niche, including the products, market,
services, and nontraditional activities.

B.

If in a holding company structure, discuss the operations of the organization, including a brief
detail of the organizational structure and interaction between the institution and its affiliates.

C.

Describe the extent, if any, that there are or will be transactions with affiliated entities or
persons. Include terms.

D.

Discuss the legal form and stock ownership of the institution and any investment in subsidiaries
or service corporations.

E.

For an operating company, describe the present financial condition and current resources, such
as office network, staff, and customer base. Specifically discuss the strengths and weaknesses.

F.

Describe the proposed location, office quarters, and any branch structure.

G.

Discuss any growth or expansion plans, including additional branches, other offices, mergers, or
acquisitions.

Marketing Plan
A marketing plan should provide in detail factual support that the institution has reasonable prospects
to achieve the revenue projections, customer volume, and key marketing and income targets. The
analysis should be based on the most current data available, and the sources of information should be
referenced. This section should contain an in-depth discussion of the major planning assumptions for
the market analysis, economic, and competitive components used to develop the plans, objectives, and
the basis for the assumptions.
A. Product

Strategy

1) List and describe the general terms of the planned products and services, including activities
of any subsidiaries. Discuss any plans to engage in any subprime or speculative lending,
including plans to originate loans with high loan-to-value ratios.
2) Discuss how the institution will offer products and services over the three years, indicating
any variation in the different market areas or distribution channels, and include the time
frame for the introduction and the anticipated cost associated with each.
19

3) Describe the institution’s plans to engage in any secondary market/mortgage banking
activity, including loan participations. Discuss plans to use forward take-out commitments
or engage in loan securitization. Describe any plans to engage in hedging activity to mitigate
the risks of this activity. Also, discuss plans to retain recourse and servicing.
4) Describe the primary sources of loans and deposits and the major methods to solicit them. If
using brokers or agents, provide full details of the nature and extent of all such activities,
including sources, amounts, fees, and any intended tie-in of compensatory arrangements with
the broker or agent.
5)
B. Market

C.

9

Describe any arrangements with e-commerce businesses (for example, links to another’s
Web site to shop, order, or purchase goods and/or services online).
Analysis

1)

Describe the intended target market and the geographical market area(s).

2)

Describe the demographics of the target market population (for example, age, education,
and occupation).

3)

For an OTS filing, discuss in detail any current and/or proposed actions to accomplish the
institution’s commitment to promote home financing.

Economic Component9
1)

Describe the economic forecast for the three years of the plan. The plan should cover the
most likely scenario and discuss possible economic downturns.

2)

Indicate any national, regional, or local economic factors that may affect the operations
of the institution. Include an analysis of any anticipated changes in the market, the
factors influencing those changes, and the effect they will have on the institution.

3)

Describe the current economic characteristics of the proposed market(s), for example,
size, income, and industry and housing patterns.

4)

Based on the economic characteristics described previously, discuss the economic factors
that influence the products and services to be offered. A more in-depth discussion is
warranted when different types of services are identified for different market areas in the
Description of Business section.

If obtained, discuss any independent economic survey or market feasibility study.
20

D. Com

V.

VI.

VII.

petitive Analysis

1)

Compare and contrast the institution’s product strategy with its principal competitors in
the target market(s). Include expected results in terms of relative strength, market share,
and pricing.

2)

Discuss the overall marketing/advertising strategy, including approaches to reach target
market through the marketing of brand, products, and services. Outline the specific
medium that will be used, including timing and level of advertising efforts.

3)

Discuss potential competition in the target market(s).

Management Plan — Directors and Officers
A.

Provide the number of organizers and/or directors. Provide a list of board committees and a brief
explanation of the responsibilities of each committee.

B.

Describe the organizational structure and provide an organizational chart, indicating the number
of officers and employees. Describe the duties and responsibilities of the senior executive
officers. Describe any management committees that are or will be established.

C.

Discuss the institution’s plans to address management succession, including any management
training program or other available resources.

Records, Systems, and Controls
A.

Describe the institution’s current and/or proposed accounting and internal control systems,
indicating any use of electronic processing systems.

B.

Describe m anagement’s proposed internal aud it function. The description should set forth the
independence of the departm ent and the scope a nd frequency of audits. Discuss the experience
and education of the audit staf f. If external a uditors will be used f or internal audits, provide
similar information for the external auditors.

C.

Describe the compliance management programs, addressing independence, scope, frequency,
and staff qualifications. Discuss how the institution will respond to consumer complaints.

D.

State plans for an annual audit by independent public accountants.

E.

Discuss the functions that will be outsourced and what the institution will do in-house.

Financial Management Plan
A.

Capital and Earnings
1)

Discuss the capital goals and the means to achieve them.
21

B.

C.

10

2)

Discuss the earnings goals in terms of return on assets, net interest margin, or other
profitability measurements, and summarize the strategies to achieve those goals.

3)

Discuss the plan for raising capital and for financing growth, with particular emphasis on
conformance with regulatory capital requirements.

4)

Discuss the adequacy of the proposed capital structure relative to internal and external
risks, planned operational and financial assumptions, including technology, branching,
and projected organization and operating expenses. Present a thorough justification to
support the proposed capital, including any off-balance-sheet activities contemplated.

5)

Describe the debt service requirements for any debt that will be issued at the holding
company level to capitalize the institution.

6)

Discuss the use of options, warrants, and/or other benefits associated with the
institution’s capital.

7)

Summarize the dividend policy.

Liquidity and Funds Management
1)

Discuss how the institution will identify and measure liquidity risk.

2)

Discuss the institution’s plan to monitor and control its liquidity risk, including funding
sources (deposits, borrowings, securitizations). Include holding company support, if any.

3)

Describe any plans to borrow funds from any financial institutions or other sources,
including the amount, composition, interest rate, maturity, purpose, and collateral.

4)

Discuss the type of investment securities the institution plans to purchase.

Sensitivity to Market Risk
1)

Discuss the institution’s objectives, strategies, and risk tolerance for interest rate risk.

2)

Discuss how the institution will identify and measure interest rate risk.

3)

Discuss the institution’s asset and liability portfolio in terms of sensitivity to interest rate
changes and the impact of earnings and capital and net portfolio value.10 Discuss the
risk limits to control interest rate risk.

4)

Describe any plans to use hedging activities (for example, futures, options, interest rate
swaps, or other derivative instruments).

For OTS filing, see Thrift Bulletin 13a.
22

D.

Credit Risk
1)

Discuss how the institution will identify and measure credit risk.

2)

Describe the loan review program, addressing independence, scope, frequency, and staff
qualifications.

3)

Describe the methodology used to determine the allowance for loan and lease losses.

VIII. Monitoring and Revising the Plan

IX.

A.

Describe how the board of directors will monitor adherence to the business plan.

B.

Describe how the board of directors will adjust and amend the plan to accommodate significant
or material economic changes.

Alternative Business Strategy (Optional unless your regulator requires)
An alternative business strategy details how an institution will operate under scenarios in which market
conditions differ significantly from those projected in this business plan. This alternative business
strategy should be realistic about the business risks and incorporate sound management of such risks.
This alternative strategy should consider potential adverse scenarios relating to the asset or liability
mixes, interest rates, operating expenses, marketing costs, and growth rates. This discussion should
include realistic plans for how the bank would access additional capital, if needed, in the future and, if
applicable, contingency funding plans that address strategies for managing potential liquidity
fluctuations. This plan also should discuss any financial safeguards to offset unexpected costs and
remain well capitalized.
Periodically, the institution should update this s
complex and as industry conditions change.

X.

ection, especially as the institution becom

es m ore

Financial Projections
A. Provide financial information for opening day pro forma and quarterly projections for the three years
of operations. Also provide annual totals for the Income Statement. The line items in the financial
statements should be consistent with the Consolidated Reports of Condition and Income or the Thrift
Financial Report (Report)11 so that projected items may be compared conveniently with actual
performance. The following reports should be used:

11

See FDIC’s Web site, http://www.fdic.gov/regulations/resources/call/crinst/callinst.html or http://www.ots.treas.gov (link to TFR
form and instructions).

Projected Balance Sheet (Schedule RC or SC)
Projected Income Statement (Schedule RI or SO)
23

Regulatory Capital Schedule (Schedule RI-A or CCR)
The financial statements should be presented in two ways: (1) showing the dollar
amounts, and (2) as a percentage of total assets.
1)

Describe in detail all of the assumptions used to prepare the projected
statements, including the assumed interest rate scenario for each interest earning
asset and interest costing liability over the term of the business plan. Also
present a thorough justification to support proposed capital, including any
branch expansion and off-balance-sheet activities contemplated.

2)

Provide the basis for the assumptions used for noninterest income and
noninterest expense. Indicate the amount of lease expense, capital
improvements, and furniture, fixtures, and equipment, including systems and
equipment upgrades.

3)

Describe the assumptions for the start-up costs, volumes, expected returns, and
expected time frame to introduce each new product and service.

B.

Discuss how the institution used marketing studies or surveys to support the
institution’s projected growth.

C.

Discuss the level of marketing expenses necessary to achieve the projected market share
for both loan and deposit products. Assumptions should be consistent with those
experienced by other institutions in the target market. Explain any significant variances
between the assumptions in the target market.

D.

Provide a sensitivity analysis of the financial projections. A sensitivity analysis
provides a realistic stress test of the major underlying assumptions used in the business
plan and the resultant financial projections. For example, adjust the financials to reflect
the effects of adverse changes in the interest rate environment, changes in the
asset/liability mix, higher than expected operating expenses, marketing costs, and/or
growth rates.

CALL REPORT
FINANCIAL PROJECTIONS
BALANCE SHEET
Assets
Cash and balances due from depository institutions
Noninterest-bearing balances and currency and coin
Interest-bearing balances
Securities
Held-to-maturity securities
Available-for-sale securities
Federal funds sold and securities purchased under agreements to resell
Loans and lease financing receivables
Construction and land development loans secured by real estate
Secured by farmland
Revolving, open-end loans secured by 1-4 family residential
Other first lien loans secured by 1-4 family residential
Other junior lien loans secured by 1-4 family residential
Secured by multifamily residential properties
Secured by nonfarm nonresidential properties
Loans to depository institutions
Loans to finance agricultural production and other loans to farmers
Commercial and industrial loans
Acceptances of other banks
Credit card and related plans to individuals
Other loans to individuals for household, family and other personal expenditures
Obligations (other than securities and leases) of states and political subdivisions in the U.S.
All other loans (exclude consumer loans)
Lease financing receivables (net of unearned income)
Less:
Unearned income
Allowance for loan and lease losses
Total Loans and leases, net of unearned income and allowance
Other Assets
Trading assets
Premises and fixed assets
Other real estate owned
Investments in unconsolidated subsidiaries and associated companies
Customers’ liability to this bank on acceptances outstanding
Intangible assets
All other assets (describe)

Total Assets

25

CALL REPORT
FINANCIAL PROJECTIONS
BALANCE SHEET (Continued)
Liabilities
Transaction deposit accounts
Demand
NOW accounts, ATS accounts, and other interest bearing transaction accounts
Nontransaction Deposit Accounts
Money market deposit accounts (MMDAs)
Other savings deposits
Time deposits of $100,000 or more
Time deposits of less than $100,000
Other nontransaction accounts (describe)
Other Liabilities
Federal funds purchased and securities sold under agreements to repurchase
Demand notes issued to the U.S. Treasury
Trading liabilities
Borrowed money with remaining maturity of one year or less
Borrowed money with remaining maturity of more than one year through three years
Borrowed money with remaining maturity of more than three years
Bank's liability on acceptances executed and outstanding
Subordinated notes and debentures
All other liabilities (describe)

Total Liabilities
Equity Capital
Common stock
Surplus
Undivided profits
Other equity capital (describe)

Total Equity

26

CALL REPORT
FINANCIAL PROJECTIONS
REGULATORY CAPITAL
Total Equity
Other Tier 1 Capital (describe)

Total Tier 1 Capital
Allowance for Loan and Lease Losses
Other Tier 2 Capital (describe)

Total Assets
Total Risk Weighted Assets

Total Tier 1 and Tier 2 Capital

Capital Ratios
Tier 1 Capital / Total Risk Weighted Assets
Total Tier 1 and Tier 2 Capital/Total Risk Weighted Assets
Tier 1 Capital /Total Assets

ALLOWANCE FOR LOAN AND LEASE LOSSES
Beginning balance
Current quarter's:
Recoveries
Provision for loan and lease losses
Less: Charge-offs
Allowance ending balance

27

FINANCIAL PROJECTIONS
INCOME STATEMENT
Interest Income
Real estate loans
Installment loans
Credit card loans
Commercial (time and demand) and all other loans
Lease financing receivables
Balances due from depository institutions
Taxable securities issued by states and political subdivisions in the U.S.
Tax-exempt securities issued by states and political subdivisions in the U.S.
U.S. Government and other debt securities
Equity securities
Interest income from trading assets
Federal funds sold and securities purchased under agreements to resell
Other interest income (describe)
Total Interest Income
Interest Expense
Transaction accounts (NOW accounts, ATS accounts, and other)
Money market deposit accounts
Other savings deposits
Time deposits of $100,000 or more
Time deposits of less than $100,000
Federal funds purchased and securities sold under agreements to repurchase
Demand notes issued by the U.S. Treasury, trading liabilities, and other borrowed money
Subordinated notes and debentures
Other interest expense (describe)
Total Interest Income
Net Interest Income
Provision for Loan and Lease Losses
Noninterest income
Service charges on deposit accounts
Other fee income
All other noninterest income
Realized gains (losses) on held-to-maturity securities
Realized gains (losses) on available-for-sale securities
Noninterest expense
Salaries and employee benefit expense
Premises and fixed assets
Other noninterest expense
Income (loss) before income taxes and extraordinary items and other adjustments
Applicable income taxes
Extraordinary items and other adjustments, net of income taxes
Net Income (Loss)
Dividends
Other changes in capital (describe)
Ending Equity Capital
28

FINANCIAL PROJECTIONS
INTEREST INCOME & INTEREST EXPENSE
ASSUMPTIONS
Average
Balance

For each quarter

Interest
Rate

Real estate loans
Installment loans
Credit card loans
Commercial (time and demand) and all other loans
Lease financing receivables
Balances due from depository institutions
Taxable securities issued by states and political subdivisions in the U.S.
Tax-exempt securities issued by states and political subdivisions in the U.S.
U.S. Government and other debt securities
Equity securities
Interest income from trading assets
Federal funds sold and securities purchased under agreements to resell
Other interest income
Average
Balance

For each quarter
Transaction accounts (NOW accounts, ATS accounts, and other)
Money market deposit accounts
Other savings deposits
Time deposits of $100,000 or more
Time deposits of less than $100,000
Federal funds purchased and securities sold under agreements to repurchase
Demand notes issued by the U.S. Treasury, trading liabilities, and other
borrowed money
Subordinated notes and debentures
Other interest expense

29

Interest
Rate

Form 1 – Balance Sheet

The Balance Sheet should be prepared showing each quarter end starting with the most current actual quarter
end and projecting each quarter for years 1, 2, and 3. The balance sheet should be presented in two ways: (1)
showing dollar amounts, and (2) as a percentage of total assets.
This balance sheet format is consistent with the TFR, but may show less detail if certain line items are
not significant. Additional detail may be included, but these items at a minimum, should be shown.

ASSETS

TFR
Item
SC

Cash and
NonInterest-Earning
Deposits

110

Total cash,
noninterest earning
deposits, and
investment securities

10

COMMENTS
This column provides brief reference information. Additional
information on individual line items is available in the TFR manual.

Use one or more line items to show the amounts and types of investment
securities. The line items should provide sufficient detail so that one can
conclude that the institution’s investment policy objectives are being met.
State the amount of securities designated as “held-to-maturity,”
“available-for-sale,” and “trading.” Separately state the categories in the
balance sheet, or provide a separate schedule or narrative description.
The TFR has separate line items for accrued interest receivable -SC 190
and GVAs SC199. These line items are optional for the plan.
State
whether you will have GVAs for your investment portfolio. If so, provide
an explanation.

Mortgage Pool
Securities

20

Provide sufficient detail so that one may review and conclude that the
institution’s investment policy objectives are being met. State the
amount of securities designated as “held-to-maturity,” “available-forsale,” and “trading.” Separately state the categories in the balance
sheet, or provide a separate schedule or narrative description.
The TFR has separate line items for accrued interest receivable - SC 220
and GVAs SC 227. These line items are optional for the plan. State
whether you have GVAs for your mortgage pool securities portfolio. If
so, provide an explanation.

Construction 1-4s

230

Construction loans should be reported net of loans in process.

Construction 5+, and
NonResidential

235
240

Construction loans should be reported net of loans in process. If the level
for each activity is significant, report these line items separately,
otherwise combine them.

Permanent 1-4 unit
residential loans.

250
253

SC 250 is “closed-end first mortgages and junior liens” and SC 253 is
“revolving, open-end loans.” These two items may be combined, but
report them separately if the level of SC 253 is significant.

30

ASSETS

TFR
Item
SC

COMMENTS
This column provides brief reference information. Additional
information on individual line items is available in the TFR manual.

Permanent 5+,
nonresidential, and
land loans

256
260
265

If the level of each activity is significant, report these line items
separately, otherwise combine them.

Accrued Interest
Receivable, and
Advances for Taxes
and Insurance

272
275

Allowance for Loan
and Leases Losses
on Mortgage Loans

283

Total Mortgage
Loans

23

Commercial Loans

32

(Non-real estate) Provide detail by type of loan if portfolios are
significant.

Consumer Loans

34

Provide detail by type of loan if portfolios are significant.

Accrued Interest
Receivable

348

Allowance for Loan
and Lease Losses
on NonMortgage
Loans

357

Total NonMortgage
Loans

30

REO

40

Report REO net of GVAs

REI

45

Report REI net of GVAs

Office Premises &
Equipment

55

Goodwill and Other
Intangible Assets

660

(continued)

31

Form 1 – Balance Sheet

ASSETS
(continued)

TFR
Item
SC

All Other assets

Total Assets

LIABILITIES

Use one or more line items to show the amounts and types of “other
assets.” The total amount of “other assets” should tie to the sum of TFR
items 50, 642, 644, 655, 690, and 699 if those items were reported
separately.
SC 60

TFR
Item
SC

Net deposits

710

Advances from
FHLB

720

Federal Funds
Purchased and
Securities Sold
Under Agreement to
Repurchase

730

Subordinated Debt
(including mandatory
convertible
securities)

735

CMOs (including
REMICs) issued

740

Other Mortgage
Collateralized
Securities Issued

745

Other Borrowings

760

Total Borrowings

72

Other Liabilities

COMMENTS
This column provides brief reference information. Additional
information on individual line items is available in the TFR manual.

COMMENTS
This column provides brief reference information. Additional
information on individual line items is available in the TFR manual.

The sum should tie to the sum of TFR line items 75 “other liabilities,” 783
“escrows,” and 715 “unamortized yield adjustments on deposits,” if those
items were reported separately

32

LIABILITIES
(continued)

TFR
Item
SC

Total Liabilities

70

Redeemable
Preferred
Stock/Minority
Interest

799

COMMENTS
This column provides brief reference information. Additional
information on individual line items is available in the TFR manual.

TFR
Item
SC

COMMENTS
This column provides brief reference information. Additional
information on individual line items is available in the TFR manual.

Perpetual Preferred
Stock

812
814

812 is Cumulative, 814 is Noncumulative. Report these items separately
if amount is greater than zero.

Common Stock - Par
Value

820

Paid in Excess of
par

830

Unrealized Losses
on Available for Sale
Securities

860

Retained Earnings

880

Other Components
of Equity Capital

890

Subtotal Equity
Capital

80

Total Liabilities,
Redeemable
Preferred Stock/
Minority Interest, and
Equity Capital

90

CAPITAL

Describe if amount is different than 0.

33

Form 2 – Income Statement

The Income Statement should be prepared beginning with the most current actual quarter, and
projected for each quarter for Years 1, 2, and 3. The income statement should be presented in
two ways: (1) showing dollar amounts, and (2) as a percentage of average total assets.
INCOME STATEMENT
Show these items at a minimum.
Interest Income
Deposits/Investment
Mortgage Pool Securities

TFR
Item
SO
110
120

Mortgage Loans

140

Commercial Loans

160

Consumer Loans

170

Amortization of Deferred Gain/Losses
on Asset Hedges

180

Subtotal: Interest Income

11

Interest Expense
Deposits

215

Advances from FHLB

266

Subordinated Debentures

230

Mortgage Collateralized Securities
Issued

240

Other Borrowed Money

260
Should tie to sum of TFR items SO 215, SO 280,
SO 290, minus SO271, if those items were
reported separately.

Other Interest Expense
Subtotal Interest Expense
Net Interest Income Before Provision for
Losses on IBA

21
311

Provision for Losses on IBA

321

Net Income After Provision for Losses on
IBA

331

NonInterest Income
Mortgage Loan Servicing Fees
Other Fees and Charges

410
420
Should tie to sum of TFR items SO 430, 461, 465,
467, 475, 477, 485, and 491, if those items were
reported separately.

Other NonInterest Income
Subtotal NonInterest Income

COMMENTS
Format is consistent with the TFR

40

34

INCOME STATEMENT
Show these items at a minimum
(continued)

TFR
Item
SO

NonInterest Expense
All Personnel Expense
Office Occupancy Expense

510
530

Amortization of Goodwill

560

COMMENTS
Format is consistent with the TFR

Should tie to sum of TFR items SO 510, 540, 550,
570, and 580, if those items were reported
separately.

Other NonInterest Expense
Subtotal NonInterest Expense

51

Income (Loss) Before Income Tax

60

Federal Taxes

710

State /Local/Other Taxes

720

Extraordinary Items

811

Net Income (Loss)

91

35

Net of tax, and cumulative effect of Changes in
Acctg Principles

Section: Business Plan Guidelines

Section 625
Form 3 – Statement of Changes in Stockholder’s Equity

A forecast of the changes in stockholders’ equity should be prepared in a form at substantially similar
to the format shown here:
Beginning Stockholders Equity
Year 1
Net Income – Year 1
Cash Dividends Declared
Repurchase of Stock
Other Comprehensive Income
Other Changes

Ending Stockholders Equity
Year 1
Net Income – Year 2
Cash Dividends
Repurchase of Stock
Other Comprehensive Income
Other Changes

Ending Stockholders Equity
Year 2
Net Income – Year 3
Cash Dividends
Repurchase of Stock
Other Comprehensive Income
Other Changes

Ending Stockholders Equity
Year 3

36

Form 4 – Table of Regulatory Capital Levels

This schedule should be prepared beginning with the m ost current quarter, and projected for each
quarter for Years 1, 2, and 3. Provide supporting schedules for each capital level.

STOCKHOLDER’S EQUITY

Dollar Amount

Tangible Capital
Core Capital
Risk-Based Capital

37

Percent %

Section: Business Plan Guidelines

Section 625
Form 5 – Table of Loan Origination Levels

A forecast of loan origination levels should be prepar ed in a format substantially similar to the format
here:
TFR
Item
Construction 1-4s

230

Construction 5+

235

NonResidential

240

Permanent 1-4 unit
Residential loans.

250
253

Permanent 5+,

256

Permanent
Nonresidential

260

Land Loans

265

Total Mortgage
Loans

23

Commercial Loans
(non-real estate)

32

Consumer Loans

34

Year 1

Year 2

38

Year 3

Form 6 – Interest Rate Assumptions for New Production

A forecast of interest rate assumptions should be prepared in a similar format as presented here:
Year 1
Q1
Construction 1-4s

230

Construction 5+

235

NonResidential

240

Permanent 1-4 unit
Residential loans.

250
253

Permanent 5+,

256

Permanent
Nonresidential

260

Land Loans

265

Total Mortgage
Loans

23

Commercial Loans
(non-real estate)

32

Consumer Loans

34

Q2

Year 2

Q3

Q4

39

Q1

Q2

Q3

Year 3
Q4

Q1

Q2

Q3

Q4