NCUA 9500 Application and Agreements for Insurance of Accounts

OMB No. 3133-0015

APPLICATION AND AGREEMENTS FOR INSURANCE OF ACCOUNTS
Date:
TO: The National Credit Union Administration Board (Board)
The proposed

Federal Credit Union

(Street Address)
(City) (State) (Zip Code)
applies for insurance of its accounts as provided in Title II of the Federal Credit
Union Act, and in consideration of the granting of insurance, hereby agrees:
1.

To pay the reasonable cost of such examinations as the Board may deem
necessary in connection with determining the eligibility of the application for
insurance.

2.

To permit and pay the reasonable cost of such examinations as in the
judgment of the Board may from time to time be necessary for the protection
of the fund and other insured credit unions.

3.

To permit the Board to have access to any information or report with respect
to any examination made by or for any public regulatory authority and
furnish such additional information with respect thereto as the Board may
require.

4.

To provide protection and indemnity against burglary, defalcation, and other
similar insurable losses, of the type, in the form, and in an amount at least
equal to that required by the laws under which the credit union is organized
and operates.

5.

To maintain such special reserves as the Board, by regulation or in special
cases, may require for protecting the interest of members.

6.

Not to issue or have outstanding any account or security the form of which,
by regulation or in special cases, has not been approved by the Board.

7.

To pay and maintain the capitalization deposit required by Title II of the
Federal Credit Union Act.

8.

To pay the premium charges for insurance imposed by Title II of the Federal
Credit Union Act.

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9.

To comply with the requirements of Title II of the Federal Credit Union Act
and of regulations prescribed by the Board pursuant thereto.

10. To permit the Board to have access to all records and information
concerning the affairs of the credit union and to furnish such information
pertinent thereto that the Board may require.
11. To comply with Title 18 of the United States Code and other pertinent Federal
statutes as they may exist or may be hereafter promulgated or amended.

We, the undersigned, certify to the correctness of the information submitted. We,
the undersigned, further certify that to the best of our knowledge and belief no
proposed officer, committee member, or employee of this credit union has been
convicted of any criminal offense involving dishonesty or a breach of trust,
except as noted in attachments to this application. We further agree to notify the
Board if any proposed or future officer commits a criminal offense.

Chairperson

Chief Financial Officer

Note: A willfully false certification is a criminal offense. U.S. Code, Title 18., Sec.
1001.

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