Application - Interim National Bank Charter

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

Interim Bank Charter Application
General Information and Instructions
Preparation and Use
This application is used to effect a transaction under 12 CFR 5.33(e)(4) to establish an interim
national bank or an interim federal savings association (interim bank).
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 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 an interim bank charter application. The OCC grants conditional
preliminary approval to form an interim bank charter when the OCC acknowledges receipt of the
related business combination. The OCC grants final approval of an interim bank charter when
the related business combination is approved. For information regarding applicable 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.
Notice of Publication
Generally, a separate public notice under 12 CFR 5.8 does not apply to an interim bank
application, unless the OCC determines that the application presents a significant or novel
policy, supervisory, or legal issue where a public notice is considered necessary. The OCC treats
the application to organize an interim bank as part of the related application to engage in a
business combination and does not require a separate public notice.
If a notice is required, the applicant must publish notice describing the entire transaction in a
newspaper of general circulation in the community or communities in which the applicant
proposes to engage in business. The OCC will provide specific requirements for the notice of
publication.

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Submission
In addition to an original application and the appropriate number of signed copies, submit an
electronic copy of the information in the application, especially of 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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Interim Bank Charter Application
Applicant
_____________________________________________________________________
Name
Charter no.
_____________________________________________________________________
Current street address
_____________________________________________________________________
City
County
State
Zip code

Parent Company Identifying Information (if applicable)
_____________________________________________________________________
Name
_____________________________________________________________________
Street
_____________________________________________________________________
City
State
Zip code

Contact Person
_____________________________________________________________________
Name
Title
_____________________________________________________________________
Employer
_____________________________________________________________________
Street
_____________________________________________________________________
City
State
Zip code
_____________________________________________________________________
Telephone no.
Fax no.
E-mail address

1. Overview
•

Indicate the type of interim association being applied for:
Federal charter
Resulting
Non-resulting
Stock savings association
Mutual savings association
National bank

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•

Provide a copy of the related business combination filing if filed with another regulator
and indicate the status of that application.

2. Corporate status
•

•

National banks submit for the interim bank:
i. Articles of Association – executed
ii. Organizing Certificate
iii. Oath of Directors for national banks
Federal savings associations submit for the interim bank:
i. Charter
ii. Bylaws
iii. Oath of Directors for federal savings associations

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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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