NCUA 4015-EZ Application FOM Amendment (Multiple Common Bond Expansio

OMB No. 3133-0015

APPLICATION FOR FIELD OF MEMBERSHIP AMENDMENT
NCUA FORM 4015-EZ
USE FOR MULTIPLE COMMON BOND EXPANSIONS OF LESS THAN 3,000
PERSONS AND ALL SINGLE COMMON BOND EXPANSIONS
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:

4. Multiple Common Bond Expansions Only: 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;
† the number of persons to be added and the group’s location(s); and
† the group’s distance to the credit union’s nearest service facility.
5. Single Common Bond Expansions Only: How the group shares the occupational
or associational common bond

NCUA 4015-EZ

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How many primary potential members (excluding immediate family and household
members) are in the group:
Name and title of credit union board-authorized representative (e.g., President/CEO):

(Typed/Printed Name and Title)

_____________________________________________________________________
(Signature)
(Date)

NCUA 4015-EZ

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