Branch and Relocation Application - Redlined

Office of the Comptroller of the Currency
OMB no. 1557-0014
Expiration Date: See www.occ.gov

Branch and Relocation Application
General Information and Instructions
Preparation and Use
This application is used to effect a transaction under 12 CFR 5.30, 5.31, and 5.40 for branch establishments
and relocations.
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 crossreference to the information is acceptable. Any cross-reference must be made to a specific cite or location
in the documents, so the information can be found easily. Supporting information for all relevant factors,
setting forth the basis for the applicant's conclusions, should accompany the application. The regulatory
agency may request additional information.
This application form collects information that the Office of the Comptroller of the Currency (OCC) will
need to evaluate a branch establishment or relocation application. The OCC must consider the applicable
statutory and regulatory requirements set forth above 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, refer to the OCC's procedural guidelines
in the Comptroller's Licensing Manual. The applicant may contact the OCC directly for specific instruction
or visit the OCC's Web site at www.occ.gov.
Unless specifically identified, this application uses the term “bank” to describe requirements applicable to
both national banks and federal savings associations (FSA). Unless noted as “federal savings association”
or “national banks only,” all questions should be answered. State savings associations establishing branches
in Washington, D.C., should follow instructions for FSAs. Please note that national banks and FSAs that
meet the exception requirements of 12 CFR 5.30, 5.31, and 5.40 should follow the appropriate notice
procedures.
Notice of Publication
A public notice is required for all branch establishment and relocation applications. The applicant must
publish notice of the proposed branch establishment or branch/main/home office relocation in a newspaper
of general circulation in the community or communities in which the applicant proposes to establish or
relocate the branch or main/home office.
There are optional and mandatory requirements for the notice of publication. The following optional
language may be used to meet the publication requirements.

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Notification is given that (name of bank), (street address, city, state, and zip code) has filed an application
with the Comptroller of the Currency on (date), as specified in 12 CFR 5 for permission to (establish or
relocate) a branch office [describe type of branch] or relocate a main/home office at (proposed location).
[If a relocation, indicate current and proposed addresses.] Any person wishing to comment on this
application may file comments in writing with the Director for District Licensing [insert address of
appropriate district office] or (appropriate e-mail address) within 30 days [15 days for short-distance
relocations] of the date of this publication.
•
•
•
•
•

•
•

Specific publication requirements: Please refer to the “Publication” section of the "Branches and
Relocations" booklet of the Comptroller's Licensing Manual.
Branch: The publication must state that an application is being filed to establish a branch and include
the location of the proposed branch and a brief description of the type of branch proposed.
Branch relocation: The publication must state that an application is being filed to relocate a branch. It
must include the current and proposed site.
Main/home office relocation: The publication must state that an application is being filed to relocate
the main/home office. It must include the current and proposed site.
Messenger service or mobile branch: Publication in several newspapers may be required to establish
messenger services or mobile branches that will serve several communities or geographic areas. The
publication need not identify the specific sites to be served by the messenger service or mobile branch,
but it should state the general geographic area to be served, such as the city, county, or other specific
geographic area. In certain circumstances, however, the OCC may require publication of specific sites
to be served. See the “Messenger Service or Mobile Branch” section of the "Branches and Relocations"
booklet of the Comptroller's Licensing Manual.
Jointly owned branch: The publication must list all depository institutions that would own the branch.
Intermittent branch: The publication must indicate the intermittent nature of the branch, including a
description of the event and its location, as well as the frequency and time period(s) the branch would
be open.

Please see the “Branches and Relocations” booklet of the Comptroller's Licensing Manual for a discussion
of the various types of branches.
Submission
In addition to an original application and the appropriate number of signed copies, submit an electronic
copy of the information in the application, including the business plan's financial projections, if applicable.
For e-mail submissions, contact the OCC 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
USC 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 application.
Contact the OCC for any further questions regarding requests for confidential treatment.
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Branch and Relocation Application
Applicant
Name

Charter Number

Street Address
County

City

State

Parent Company Identifying Information (if applicable):
Name

Street Address
City

State

Zip Code

Contact Person:
Title

Name

Employer
Street Address
City
Phone No.

State
Fax No.

E-mail

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Zip Code

Zip Code

FEDERAL SAVINGS ASSOCIATIONS ONLY
TYPE OF APPLICATION (Check appropriate boxes)
BRANCH ESTABLISHMENT (Including expansion of mobile branch service area)
Staffed branch

Temporary facility

Drive-in facility

College or University

Jointly owned

Major disaster

Intermittent facility

Other

Please specify

Mobile facility
Mobile van
Messenger service
Other

Please specify

BRANCH ESTABLISHMENT LOCATION (Select One)
District of Columbia (FSA)

District of Columbia (State Savings Assn.)

Any other location (FSA)

BRANCH RELOCATION
Note: Branch relocations that do not meet the short distance criteria of 12 CFR 5.3(I) must also comply with advance branch closing
procedures in 12 USC 1831r-1.

District of Columbia (FSA)

District of Columbia (State Savings Assn.)

Any other location (FSA)

HOME OFFICE RELOCATION
Note: If the relocation is to an existing branch within the same city, town, or village limits, no application is required. File a notice instead.

NATIONAL BANKS ONLY
TYPE OF APPLICATION (Check appropriate boxes)
BRANCH ESTABLISHMENT (Including expansion of mobile branch service area)
Staffed branch

Mobile facility

Seasonal agency

Mobile van

Night depository/drop box

Messenger service

Drive-in facility

Other

Jointly owned

Temporary facility

Intermittent facility

Please specify

College or university
Major disaster
Other

Please specify

Check the following as applicable:
Interstate
Note: (Riegle-Neal. The proposed new or relocated branch is to be located in a state that is not the bank's main office state and in which the

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bank will not operate at least one authorized branch at the time the proposed branch will open.)

Intrastate
BRANCH RELOCATION
Note: Branch relocations that do not meet the short distance criteria of 12 CFR 5.3(I) must also comply with advance branch closing
procedures in 12 USC 1831r-1.

MAIN OFFICE RELOCATION
Note:
•If the main office relocation is beyond 30 miles of the city, town, or village limits of which it is currently located, this application does not
apply. Contact the appropriate OCC licensing office.
•If the relocation is to an existing branch within the same city, town, or village limits, no application is required. File a notice instead.

ALL BANKS
OFFICE LOCATION
New Branch Establishments Only
Provide the proposed location for the branch.

Branch name:
Street Address:

County

City

State

Zip Code

County

State

Zip Code

County

State

Zip Code

Relocations Only (Branch or Main/Home Office)
Provide the proposed and existing location of the branch or main/home office.

From: Branch name (if applicable):
Branch cert. no. (if applicable):
Street Address
City

To:

Branch name (if applicable):
Street Address
City

Provide the mailing address of the main/home office.
The main/home office mailing address will be the same as the new location listed above.
The new mailing address for the main/home office is:

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LEGAL NOTICE
Provide the following information with respect to legal notice of the application.
Publication name
Street Address
City, state, zip code
Date of publication

1. Bank Premises
Will the projected cost of the relocation/branch establishment result in an investment in bank premises
that requires an application under 12 CFR 5.37? (See the "Investment in Bank Premises" booklet)

Yes

No

Yes
No
If “Yes,” has prior approval been granted?
If “No,” submit a separate investment in bank premises request to the appropriate OCC supervisory office for the bank.

2. Management Interlocks/Insider Transactions
Management Interlocks
Will the relocation/establishment of the proposed branch result in or raise an issue that could create a
Yes
No
prohibited interlock under 12 CFR 26?
If “Yes,” describe the management interlock and specify what action will be taken to prevent a violation of the law. (Refer to
the “Management Interlocks” booklet.)

Insider Transactions
Does this proposal involve or result in a transaction with insiders as set forth in 12 CFR 215?

Yes

No

Are there any other financial or business arrangements, direct or indirect, involving the proposed branch
or main/home office and bank insiders or their immediate family members? (Refer to the glossary of the
“Branches and Relocations” booklet for a definition of relevant terms.)

Yes

No

Does the proposal involve or result in a transaction with an affiliate as set forth in 12 CFR 223
(Regulation W)?

Yes

No

If the answer is “Yes” to any of the above questions:
A.

Identify the individual or affiliate and the interest of such individual or affiliate in the arrangement and the
relationship of such individual or affiliate to the bank.

B.

Provide information sufficient to show that terms and conditions are not more favorable than would be available
in a comparable transaction with unrelated parties. For example, attach a copy of a recent independent appraisal
or information on comparable purchases or leases in the area.

C.

Where applicable, provide information demonstrating that the requirements of 12 CFR 215 and Regulation W are
satisfied.

D.

Attach a copy of the board resolution approving details of the transaction.

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3. Environment
Will the proposal have any significant effect on the quality of the human environment, (for example, 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
(NEPA), 42 USC 4321-4347, et seq? (See the Council on Environmental Quality at https://
www.whitehouse.gov/ceq/).
If “Yes,” discuss the effect(s) and explain how the proposal causes the effects.

Yes

No

Yes

No

4. Historic Properties
Will the proposal 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 (NHPA), 54 USC
300101 et seq.)?
(See the Advisory Council on Historic Preservation at www.achp.gov for the act and implementing
regulations.)
A. Specify how such determination was made (CHECK ALL THAT APPLY):
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. (Letter of initial consultation is required in
most cases.)
Reviewed National Register of Historic Places (See http://www.nps.gov/nr/).
Applied National Register criteria to unlisted properties (See 36 CFR 60.4).
Reviewed historical records.
Contact with preservation organizations.
Other (Please describe):

B. Provide copies of all correspondence with SHPO and/or THPO.
If no documentation is provided with the application, please explain.

5. Community Reinvestment Act (CRA) Considerations
At its most recent examination, did the bank or any affiliated institution receive a CRA rating of "needs to
improve" or "substantial noncompliance"?
Will the proposed transaction affect the CRA assessment area, as applicable, served by the applicant or
resulting institution?

Yes

No

Yes

No

6. Branch Relocations Only - Branch Closing Notice
Branch relocations that do not meet the short distance criteria of 12 CFR 5.3(I) must comply with advance branch
closing procedures in 12 USC 1831r-1.z.
A. Is a copy of the 90-day advance notice branch closing notice to the OCC included in this application?
If “No,” when do you anticipate submitting this notice?
B. Is a copy of the notice to bank customers included in this application?
If “No,” when do you anticipate submitting this notice?

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Yes

No

Yes

No

FEDERAL SAVINGS ASSOCIATIONS ONLY
1. Home Office Relocation
Yes

No

B. Is the home office relocation to an authorized branch within the limits of the same city, town, or
village in which the current home office is located?
If “Yes,” please follow the notice requirements found in 12 CFR 5.40.

Yes

No

C. Is the home office relocation to an existing branch outside the city, town, or village in which the
current home office is located?
If “Yes,” please attach your amended charter to this application.

Yes

No

D. Do you certify that two-thirds of the shareholders have voted to approve the relocation?
If “No,” please explain.

Yes

No

E. Are you establishing a branch at the former home office?
If “Yes,” follow requirements of 12 CFR 5.31. (A separate branch filing may be required).

Yes

No

Yes

No

B-1. Is this a request to establish, expand, or relocate a mobile branch or messenger service?
If “Yes,” provide the specific geographic area each facility will serve.

Yes

No

B-2. Is this a request to operate more than one mobile branch or messenger service simultaneously?
If “Yes,” indicate the number of messenger services.

Yes

No

B-3. Will more than one state be served by the mobile branch or messenger service?
If “Yes,” list each state.

Yes

No

Yes

No

Yes

No

A. Is this a short distance relocation as defined in 12 CFR 5.3(l)?
Note: Branch relocations that do not meet the short distance criteria of 12 CFR 5.3(I) must also
comply with advance branch closing procedures in 12 U.S.C. 1831r-1.z.

2. Branch Establishment or Relocation
A. Is this establishment or relocation in compliance with 12 USC 1464(r)?
If “No”, please provide a legal analysis to support approval.

B. Address the following questions for all mobile facilities.

NATIONAL BANKS ONLY
1. Branch Establishment or Relocation
Note: If requesting a main office relocation, go to section 2.
1a. Address the following questions for intrastate branch establishments and relocations.
A. Does state law impose geographic, numerical, qualitative, proximity, or other limitations on the
establishment/relocation of branches?
If “Yes,” does the filing comply with those limitations?
Note: If this filing does not comply with state limitations, please provide a legal analysis to support approval.

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B. Is the relocation/establishment of the branch in compliance with the capital requirements of 12 USC
36(c)?
Note: This question is not applicable for a seasonal agency.

Yes

No

If “No,” please explain why not.

C. If this application is to establish/relocate a mobile, messenger service, intermittent, drop box,
drive-in, part-time, or temporary branch, does the state in which the branch is proposed
permit state banks to operate this type of branch at the location proposed?

N/A

Yes

No

If "No," please provide a legal analysis to support approval.

We have found no publicly available state law authority addressing this type of branch.
D. Is home state of the applicant bank different than home state of the applicant bank's bank holding
company as "home state" is defined in 12 CFR 25.62(d)(2) and (3)?
If “Yes,” go to question D-2. If “No,” go to question D-1.
D-1. Is the proposed branch in a state other than the state where the applicant bank's main office is
located?
If “Yes,” go to question D-2. If “No,” go to question E.
D-2. In the applicant bank's most recent CRA examination, did the OCC determine that the bank was
not in conformity with 12 CFR 25, Subpart E ("Prohibition Against Use of Interstate Branches
Primarily for Deposit Production") in the state where the branch is proposed?

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

(If the bank was not an OCC-regulated bank at the time of its last CRA examination, did its
federal banking regulator at that time determine that the institution was not in conformity with that
regulator's equivalent regulations?)
If “Yes,” explain how the bank will meet the credit needs of the community to be served by the
proposed branch.

E. Are there any other legal issues involved in this proposal?
If “Yes,” please provide a legal analysis and discuss the issues fully.

1b. Address the following questions for interstate branch establishments and branch relocations.
A. Address the authority to establish the branch in, or relocate it to, another state. In particular:
A-1 Does state law in which the branch is proposed to be located impose capital requirements, or
geographic, numerical, qualitative, proximity, or other limitations on the establishment/relocation of
branches?
If “Yes,” please provide a legal analysis to support approval.

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A-2 If this application is to establish/relocate a mobile, messenger service, intermittent, drop box, drive-in, part-time, or
temporary branch, does the state in which the branch is proposed, permit state banks to operate this type of branch at
the location proposed?
If "No," please provide a legal analysis to support approval.

We have found no publicly available state law authority addressing this type of branch.
A-3 Address compliance with applicable state filing requirements and indicate whether the applicant provided a copy of
the application to the appropriate state banking regulator in the state.

A-4 Address the applicability of state antitrust laws.

A-5 Address conformance with applicable federal capital and management standards.

B. If the applicant bank has no bank affiliate in the state where the branch is proposed:
B-1 Are the CRA ratings for all affiliates of the applicant that are subject to CRA at least
"satisfactory"?
If “No,” please provide details on CRA ratings and action plan.

N/A

B-2 Has the OCC determined that the applicant bank is not in compliance with applicable state
community reinvestment laws?
If “Yes,” please provide detail on CRA ratings and action plan.

C. Are there any other legal issues involved in this proposal?
If “Yes,” please provide a legal analysis and discuss the issues fully.

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

1c. Address the following question for all national bank branch relocations.
Is this a short distance relocation as defined in 12 CFR 5.3(l)?
Note: Branch relocations that do not meet the short distance criteria of 12 CFR 5.3(I) must also comply
with advance branch closing procedures in 12 USC 1831r-1.z.
1d. Address the following questions for all mobile facilities.
A. Is this a request to establish a mobile branch or messenger service?
If “Yes,” provide the specific geographic area that the facility would serve.

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B. Is this a request to expand the authorized area that will be served by an existing mobile branch or
messenger service?
If “Yes,” provide the specific new area for which the bank is seeking authorization.

Yes

No

C. Is this a request to operate more than one messenger simultaneously?
If “Yes,” indicate the number of messenger services.

Yes

No

D. Will more than one state be served by the mobile branch or messenger service?
If “Yes,” list each state.

Yes

No

A. Is the proposed main office within 30 miles of the city, town, or village of the current main office?
If “No,” this application does not apply. Contact the appropriate OCC licensing district office for
instructions.

Yes

No

B. Are you establishing a branch at the former main office?
If “Yes,” you need to file a separate branch application.

Yes

No

C. If the bank were not relocating its main office, could the bank establish a de novo branch at the
proposed new site of the main office?
If “No,” please explain.

Yes

No

D. Would the relocation of the bank's main office alter the bank's legal authority to establish or acquire
branches in any manner?
If “Yes,” please explain.

Yes

No

E. Is this a short distance relocation as defined in 12 CFR 5.3(l)?

Yes

No

1e. Address the following for jointly owned branches.
A. Provide the names and addresses of other institutions that will have an ownership interest in the branch.

2. Main Office Relocation
2a. Address the following questions for all main office relocations.

2b. Address the following for main office relocations outside the city, town, or village limits of the current
location of the main office.
A. Is the main office relocation across state lines?
If “Yes,” please identify the states.

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Yes

No

A-1. Is the bank seeking to retain a branch or branches in the state of its former main office?
If “Yes”, please explain the legal authority to retain the branches

B. Do you certify that two-thirds of the shareholders have voted to approve the relocation?
If “No,” please explain.

Desired Action Date/Acknowledgement
I/We desire OCC action on this application no later than date (mm/dd/yyyy)

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Yes

No

Yes

No

OCC CERTIFICATION
I certify that the bank's board of directors, shareholders, or a designated official has authorized the
filing of this application. I certify that the information contained in this application has been examined
carefully and is true, correct, complete and current as of the date of this submission. Additionally, I agree to
notify the OCC if the facts described in the filing materially change prior to receiving a decision or at any time
prior to consummation of the action contemplated herein.
I acknowledge that any misrepresentation or omission of a material fact with respect to this application, any
attachments to it, and any other documents or information provided in connection with this application may be
grounds for denial of the application or revocation of its approval, and may subject the undersigned to legal
sanctions, including the criminal sanctions provided for in Title 18 of the United States Code.
I acknowledge that the approval of this application is in the discretion of the OCC. The activities and
communications by OCC employees in connection with the filing, including approval of the application if
granted, do not constitute a contract, express or implied, or any other obligation binding upon the OCC, the
United States, any agency or entity of the United States, or any officer or employee of the United States, and
do not affect the ability of the OCC to exercise its supervisory, regulatory and examination authorities under
applicable law and regulations. I further acknowledge that the foregoing may not be waived or modified by
any employee or agent of the OCC or the United States.

__________________________________________
President or other authorized officer

Typed Name
Title
Employer

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