NCUA 4015 Application FOM Amendment (Multiple Common Bond Expansio

OMB No. 3133-0015

APPLICATION FOR FIELD OF MEMBERSHIP AMENDMENT
NCUA FORM 4015
USE FOR MULTIPLE COMMON BOND EXPANSION FOR GROUPS OF
3,000 OR MORE PERSONS
Attach a separate application for each group included in your request for expansion.
The application must be complete or it will be returned unprocessed.
1. Name of credit union:
Address of credit union:

Telephone Number:

Charter Number:

2. Name and address of group:

Telephone Number:
If the group is an association, include a copy of the association’s
Charter/Bylaws or other equivalent organizational documentation.
3. Provide the proposed field of membership wording. Use the example wording found
in NCUA’s Chartering and Field of Membership Manual, Chapter 2, Section IV.A.2.

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4. How many primary potential members (excluding immediate family and household
members) are in the group:
5. (a) What is the distance between the group’s location and your credit union’s nearest
service facility1 to which the group has access (Reference Chapter 2, Section
IV.A.1):
(b) What is the address of this service facility:
(c) Describe the service area2 primarily served by the above service facility:

6. Is the group in the field of membership of any other credit union?

Yes

No

If yes, and the overlapped credit union is not a community credit union or a nonfederally insured credit union, please address the following:
† Provide the name and location of the other servicing credit union:

† Include a letter from the overlapped credit union indicating whether it concurs or
objects to the overlap. If the overlapped credit union objects or fails to respond,
document attempts to resolve the issue:
† Explain how the expansion’s beneficial effect in meeting the convenience and
needs of the members of the group clearly outweighs any adverse effect on the
overlapped credit union:

1

A service facility is defined as a place where shares are accepted for members’ accounts, loan
applications are accepted or loans are disbursed.
2
A federal credit union’s service area is the area that can reasonably be served by the service
facility accessible to the groups within the field of membership. It will most often coincide with
that geographic area primarily served by the service facility.
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7. Attach a letter, or equivalent documentation, from the group requesting credit union
service indicating:
† that the group wants to be added to the federal credit union’s field of
membership;
† whether the group presently has other credit union service available;
† the number of persons currently included within the group to be added and the
group’s location(s);
† the group’s proximity to the credit union’s nearest service facility; and
† why the formation of a separate credit union for the group is not practical or
consistent with safety and soundness standards. The formation of a separate
credit union may not be practical if the group lacks sufficient volunteers or
resources to support the operation of a credit union or does not meet the
economic advisability criteria outlined in Chapter 1 of NCUA’s Chartering and
Field of Membership Manual.
8. Other comments:

Name and title of credit union board-authorized representative (e.g., President/CEO):

(Typed/Printed Name)

________________________________________________________________
(Signature)
(Date)

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