FR 2083, FR 2083A, FR 2083B, and FR 2083C

FR 2083
OMB Number 7100-0046
Approval expires December 31, 2022
Page 1 of 7

DRAFT
Board of Governors of the Federal Reserve System

Application to the Board of Governors of the
Federal Reserve System for Membership in the
Federal Reserve System—FR 2083
An application is authorized by Sections 9 and 19 of the Federal
Reserve Act, 12 U.S.C. §§ 321-328; and related provisions of law,
and Section 208.3 of Regulation H.

NOTE: A bank located outside the United States in a dependency
or insular possession, which desires to be admitted to the System
under Section 19 of the Federal Reserve Act (12 U.S.C. § 466)
should contact the Federal Reserve Bank of which it wishes to
become a member or at which it wishes to maintain reserves.

Date of Application:
Month / Day / Year

Corporate Title of Applicant
Proposed Corporate Title of Applicant, if applicable
Street Address of Head Office
City

State

Zip Code

County

Does applicant request confidential treatment for any portion of
this submission?

Yes
As required by the General Instructions, a letter justifying
the request for confidential treatment is included.
The information for which confidential treatment is being
sought is separately bound and labeled "Confidential."

No
Name, title, address, telephone number, and e-mail address of
person(s) to whom inquiries concerning this application may be
directed:
Name

Name

Title

Title

Street Address

Street Address

City

State

Zip Code

City

Area Code / Phone Number

Area Code / Phone Number

E-mail Address

E-mail Address

State

Zip Code

12/2019

Public reporting burden for this collection of information is estimated to average 4 5 hours per response, including the time to gather and maintain data in the required form and to review
instructions and complete the information collection. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden, to: Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, N.W., Washington, DC 20551; and to the Office of Management and Budget, Paperwork
Reduction Project (7100–0046), Washington, DC 20503. The Federal Reserve may not conduct or sponsor and an organization (or person) is not required to respond to a collection of
information unless it displays a currently valid OMB control number.

12/2019

FR 2083
Page 2 of 7

General Information and Instructions
Who May Use This Form
This form should be used for an application filed by a newly organizing bank that seeks to become a state member bank, or by an
existing bank or savings institution that seeks to convert to a
state member bank status.

Preparation of Application
For relevant filing information, Applicants should consult the
Board’s Regulation H (12 C.F.R. Part 208), a copy of which is
available on the Board’s public website at http://
www.federalreserve.gov/regulations/ or from any Reserve Bank.
Additional filing information is available on the Board’s public website at http://www.federalreserve.gov/generalinfo/applications/afi/.
Inquiries regarding the preparation and filing of applications should
be directed to the Reserve Bank of the Federal Reserve district in
which the head office of Applicant is or will be located (“appropriate
Reserve Bank”). Applicants are encouraged to con- tact Federal
Reserve staff as soon as possible for assistance in identifying the
specific type of information that should be provided in the
application and to determine whether a premembership
examination of Applicant will be required. Name check and financial information (including the submission of fingerprint cards)
may be required for certain individuals associated with a proposed transaction. Such information should be submitted on the
Interagency Biographical and Financial Report (FR 2081c; OMB
No. 7100-0134), and may be submitted in advance of the application; fingerprint cards must be submitted separately. Please
contact the appropriate Reserve Bank for further guidance on the
applicability and submission of fingerprint cards.
The Federal Reserve reserves the right to require the filing of
additional statements and information. If any information initially
furnished in the application changes significantly during the processing of the application, such changes should be communicated
promptly to the Reserve Bank.
If a proposed new operating bank is involved, Applicant should
contact the appropriate Reserve Bank (before the review processes for the charter and deposit insurance of the proposed
new bank begin) to determine when the membership application
should be filed with the Federal Reserve. The organizers of certain de novo banks may be required to meet with Reserve Bank
officials during the application review process. In addition, the
appropriate Reserve Bank should be consulted regarding the
appropriate time(s) to file any other related Federal Reserve application(s), including any bank branch applications, bank merger
applications, or bank holding company applications to acquire
bank shares.
If Applicant is a de novo bank, it should complete Section I. 1 If
Applicant is a currently operating bank or thrift, it should complete
Section II. If Applicant is a newly formed, nonoperating bank
formed solely to facilitate acquisition of an existing bank, it should
complete Section III. All numbered items on the appropriate section

should be answered; if the question is not applicable or if the
answer is “none,” so state.
Applicant also must complete the appropriate Federal Reserve
Bank stock application form for its charter type (FR 2083A or FR
2083B) and the Certificate of Organizers or of Directors (FR
2083C). If the applicant is a national bank proposing to retain
their membership in the Federal Reserve System, they are not
required to complete an application (FR 2083A) for Federal
Reserve Bank stock.
Answers to questions should be numbered in accordance with
the format of this application. The application should be bound and
page numbered consecutively with numbers appearing at the
bottom of each page.
Eligible banks, as defined in Section 208.2(e) of the Federal
Reserve’s Regulation H (12 C.F.R. § 208.2(e)), and certain de
novo banks controlled by bank holding companies that meet criteria in Section 225.14(c) of the Federal Reserve’s Regulation Y
(12 C.F.R. § 225.14(c)), are eligible for expedited processing.
See Section 208.3(c) of Regulation H (12 C.F.R. § 208.3(c)). The
letter submitting the completed application should clearly indicate
if Applicant is seeking expedited processing.

Supporting Information
The formal questions in the application are not intended to limit
Applicant's presentation. In this regard, Applicant bears the full
burden of presenting and documenting a case to meet the statutory criteria for approval. 2 Supporting information for any or all factors, setting forth the basis for Applicant's judgment, may accompany the application.

Confidentiality
Under the provisions of the Freedom of Information Act (the
“FOIA”— 5 U.S.C. § 552), the application is a public document and
available to the public upon request. Once submitted, an
application becomes a record of the Board and may be requested
by any member of the public. Board records generally must be
disclosed unless they are determined to fall, in whole or in part,
within the scope of one or more of the FOIA exemptions from
disclosure. See 5 U.S.C. § 552(b)(l)-(9).
The exempt categories include (but are not limited to) ‘‘trade
secrets and commercial or financial information obtained from a
person and privileged or confidential’’ (exemption 4), and information that, if disclosed, ‘‘would constitute a clearly unwarranted
invasion of personal privacy’’ (exemption 6). An Applicant may
request confidential treatment for any information submitted in (or
in connection with) its application that Applicant believes is exempt
from disclosure under the FOIA. For example, if Applicantis of the
opinion that disclosure of commercial or financial infor- mation
would likely result in substantial harm to its competitive position or
that of its subsidiaries, or that disclosure of informa- tion of a
personal nature would result in a clearly unwarranted invasion of

Refer to SR Letter 20-16 Supervision of De Novo State
16.htm.
2 See 12 CFR 208.3.
Member Banks for additional details
https://www.federalreserve.gov/supervisionreg/srletters/SR20
1

06/2019

personal privacy, confidential treatment of such information may be requested.

06/2019

FR 2083
Page 3 of 7

General Information and Instructions—Continued
The request for confidential treatment must be submitted in writing
concurrently with the filing of the application (or subsequent related
submissions), and must discuss in detail the justification for confidential treatment. Such justification must be provided for each portion of the application (or related submissions) for which confidential
treatment is requested. Applicant’s reasons for requesting confidentiality must specifically describe the harm that would result from
public release of the information. A statement simply indicating that
the information would result in competitive harm or that it is personal in nature is not sufficient. (A claim that disclosure would violate the law or policy of a foreign country is not, in and of itself, sufficient to exempt information from disclosure. Applicant must demonstrate that disclosure would fall within the scope of one or more of
the FOIA exemptions from disclosure.) Applicant must follow the
steps outlined immediately below, and certify in the application (or
related submissions) that these steps have been followed.
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.’’
With respect to applications that include information regarding an
individual or individuals associated with the proposed transaction,
the Board expects Applicant to certify that it has obtained the consent of the individual(s) to public release of such information prior to
its submission to the Board or, in the absence of such consent, to
submit (or ensure that the individual(s) submit(s)) a timely request
for confidential treatment of the information in accordance with
these instructions. Information submitted directly by an individual or
individuals will become part of the relevant application record, and,
accordingly, will be a Board record subject to being requested by
any member of the public under FOIA.
The Federal Reserve will determine whether information submitted
as confidential will be so regarded, and will advise Applicant of any
decision to make available to the public information labeled
‘‘CONFIDENTIAL.’’ However, it shall be understood that, without
prior notice to Applicant, the Board may disclose or comment on
any of the contents of the application in the Order or Statement
issued by the Board in connection with its decision on the application. The Board’s staff normally will apprise Applicant in the course
of the review process that such information may need to be disclosed in connection with the Board’s action on the application.
For further information on the procedures for requesting confidential
treatment and the Board’s procedures for addressing such
requests, consult the Board’s Rules Regarding Availability of
Information, 12 C.F.R. Part 261, including 12 C.F.R. § 261.175, which
governs requests for confidential treatment.

Compliance
Applicant is expected to comply with all representations and
commitments made in this application. Applicant should
immediately contact the appropriate Reserve Bank if there is any
change in the structure of the proposal prior to consummation.

Filing Certification
The completed application must be submitted to the appropriate
Reserve Bank with the following certification, signed and dated
by an authorized official of the proposed member bank:
I certify that the information contained in this application hasbeen
examined carefully by me and is true, correct, and complete, and
is current as of the date of this submission to the best of my
knowledge and belief. I acknowledge that any misrepresentation
or omission of a material fact constitutes fraud in the inducement
and may subject me to legal sanctions provided by 18 U.S.C. §§
1001 and 1007.
I also certify, with respect to any information pertaining to an
individual and submitted to the Board in (or in connection with) this
application, that the Applicant has the authority, on behalf of the
individual, to provide such information to the Board and to consent
or to object to public release of such information. I certifythat the
Applicant and the involved individual consent to public release of
any such information, except to the extent set forth in a written
request by the Applicant or the individual, submitted in accordance
with the Instructions to this form and the Board's Rules Regarding
Availability of Information (12 C.F.R. Part 261), requesting
confidential treatment for the information.
I request that examiners be assigned to make any investigations
necessary.
I acknowledge that approval of this application is in the discretion
of the Board of Governors of the Federal Reserve System. Actions
or communications, whether oral, written, or electronic,by the
Federal Reserve or its employees in connection with this filing,
including approval if granted, do not constitute a contract, either
express or implied, or any other obligation binding uponthe
agency, the United States or any other entity of the United States,
or any officer or employee of the United States. Such actions or
communications will not affect the ability of the FederalReserve to
exercise its supervisory, regulatory, or examination powers under
applicable laws and regulations. I further acknowledge that the
foregoing may not be waived or modifiedby any employee or
agency of the Federal Reserve or of the United States.

09/2011

FR 2083
Page 4 of 7

SECTION I

De Novo Bank

Financial and Managerial Information
Provide the following:
1. Provide a copy of the Interagency Charter and Federal Deposit
Insurance Application (“ICDIA”) filed with the state and federal
regulatory agencies in connection with this proposal.
NOTE: The Federal Reserve does not require (1) notice of
publication of an application for membership; (2) a copy of the
electronic version of the ICDIA information provided to other
banking agencies; or (3) the Oath of Directors in connection
with the ICDIA. In addition, the Federal Reserve does not
require responses to 4(b), 5(g) and 5(i) of the ICDIA because
factors under the Community Reinvestment Act, the National
Environmental Policy Act, and National Historic Preservation
Act are not within the factors considered by the Federal Reserve

in granting membership. The Federal Reserve has different
fingerprint requirements than those reflected in the ICDIA.
Accordingly, an applicant must consult with the appropriate
Reserve Bank to determine which individuals associated with
a proposal should submit fingerprint cards.
a. If projections contained in the ICDIA do not indicate profitable operations by the end of the third year, comment as to
the reasons why and provide an estimate of the period that
will be required before operations become profitable.
b. With respect to the proposed bank’s capital accounts, de
novo banks must comply with the Federal Reserve capital
requirements for de novo banks.
c. Estimate the date on which the new bank expects to open
for business.

Note: If your proposal involves a novel business plan, including
operating as digital-only bank or those that limit traditional lending or
traditional deposit taking activities, please refer to SR Letter 12-12
Implementation of a New Process for Requesting Guidance from
the Federal Reserve Regarding Bank and Nonbank Acquisitions
and
Other
Proposals
https://www.federalreserve.gov/supervisionreg/srletters/sr1212.h
tm.

09/2011

FR 2083
Page 5 of 7

SECTION II

Currently Operating Bank

Financial and Managerial Information
Provide the following:
1. Description of any plans of Applicant (and/or Applicant's parent
company) to raise or replace Tier 1 or Tier 2 capital.
2. A list of the principals of Applicant (and/or Applicant's parent
company)1 that reflects any proposed changes or additions
after Applicant becomes a member, providing information with
respect to each principal as follows:
a. Name and address (city and state/country). If the principal's country of citizenship is different than his or her country of residence, then state the country of citizenship;
b. Titles or positions with Applicant (and/or Applicant's parent
company);
c. Number and percentage of each class of shares of
Applicant (and/or Applicant's parent company) owned,
controlled or held with power to vote by this individual. Show
separately for each listed shareholder the number of
Applicant's shares held less than twelve months prior to
date of application and furnish full details of the purchases
including dates and costs:
In responding to item 2.c or 2.e, include shares owned,
controlled or held with power to vote by principal's spouse,
dependents and other immediate family. Give record of
ownership and, to the extent information is available,
beneficial ownership of shares held by trustees,nominees,
or in street names;
d. Principal occupation if other than with Applicant (and/or
Applicant's parent company);
e. If 10 percent or more of the outstanding shares in any
other depository institution2 or depository institution holding
company are held by a principal, give name and location of
the other depository institution. Information that has been
collected and updated within the past twelve months may
be submitted unless Applicant has reason to believe that
such information is incorrect.
f. All new principals that intend to own less than 10 percent
of Applicant (or Applicant’s parent company) should submit
the biographical section of the Interagency Biographical and
Financial Form. All new principals that intend to own
10 percent or more of Applicant (and/or Applicant’s parent
company) should submit all sections of the Interagency
Biographical and Financial ReportForm.

3. A copy of the Applicant (and/or Applicant’s parent company)
shareholder list of record that reflects any proposed changes or
additions after Applicant becomes a member.
3.4. A description of recent or anticipated changes in the
manage- ment of Applicant (and/or Applicant’s parent
company). The biographical section of the Interagency
Biographical and Financial ReportForm should be provided for
any proposed new offi- cers or directors of Applicant (not
already provided in responseto question 2f).
4.5. A discussion of management's future strategic plans for the
bank, including any proposed changes in products or services. If available, a copy of the bank's current Strategic Plan
and/or Business Plan should be provided with the application.
5.6. A list of management officials3 who are also management
offi- cials of any other depository organization located in the
same Metropolitan Statistical Area (MSA) as Applicant, or—if
Applicant is not located within an MSA—in cities, towns or villages whose borders are within ten road miles at their closest
point to the city, town, or village where Applicant's main office
or branch is located. Give name and location of other depository organizations and position held in such organization.
6.7. If Applicant plans to become affiliated with another bank
hold- ing company or other business entity, give full details
regard- ing the proposed affiliation. In addition, if the proposed
acquirer(s) is (are) not existing banks or bank holding companies, explain briefly the business activities of the acquiring
party(ies).
7.8. For each subsidiary of Applicant, provide the following
informa-tion: (a) name and location; (b) brief description of the
busi- ness activities and legal authority(ies) for the activities; (c)
number of shares of each class outstanding and number owned
or controlled by the bank; and (d) recent financialstatement.
8.9. A copy of the charter (certificate of authority to commence
business) and articles of incorporation of the bank, with all
amendments to date, recently certified by the appropriate state
official. (If Applicant has been involved in a consolidation
whereby all rights, franchises, and interests of constituent
institutions pass by operation of law to the consolidated bank,
information should be furnished as to any corporate powers
acquired by the bank by virtue of such consolidation other than
those shown in its charter or articles of incorporation).
If the proposed transaction involves the issuance of a new
charter, the charter and Articles of Incorporation may be submitted in draft form (i.e., certification is not required) as soon as
the documents become available.

1. The term principal as used herein means any individual, corporation, or other entity that (1) owns or controls, directly or indirectly, individually or as
members of a group acting in concert, 10 percent or more of the outstanding shares of any class; (2) is a director, trustee, partner, or executive officer;
or (3) with or without ownership interest, participates, or has the authority to participate in major policymaking functions, whether or not the individual
has an official title or is serving without compensation. If Applicant believes that any such individual should not be regarded as a principal, Applicant
should so indicate and give reasons for such opinion.
2. For purposes of this application, a ‘‘depository institution’’ is defined as a commercial bank (including a private bank), a savings bank, a trust company,
a savings and loan association, a homestead association, a cooperative bank, an industrial bank, or a credit union.
3. “Management official” means an employee or officer with management functions (including an advisory director or honorary director), a trustee of a
026/202219

business organization under the control of trustees (e.g., a mutual savings bank), or any person who has a representative or nominee serving in any such
capacity. (See the Board's Regulation L, 12 C.F.R. §§ 212.2(h) and (k).)

026/202219

FR 2083
Page 6 of 7

Currently Operating Bank—Continued
Competition and Convenience and Needs
1. Indicate the specific location of the bank and all branches.
Include a description of the general market area (i.e., MSA,
county, city, or other such overall trade area) in which the bank
and its branches are or expect to be located. The dis- cussion
should include the size(s) in terms of population, the principal
elements of the local economy, and the future eco- nomic
outlook.

2. Provide a statement of corporate powers granted by the state
or functions that have been or are now being exercised or
performed other than those usual to commercial banking.

09/2011

FR 2083
Page 7 of 7

SECTION III

Non-Operating Bank

If Applicant is a newly formed, non-operating “shell,” formed solely
to facilitate the acquisition of an existing bank, provide an introductory
statement outlining full details of the proposed transaction.
If the bank to be acquired or merged into the shell is a state
member bank of the Federal Reserve System, no further information
is necessary unless specifically requested by the appropriate
Reserve Bank. If the bank to be acquired or merged into the shell

is not a state member bank, provide the information requested in
Section II, omitting only numbered item 76, the contents of which
should be included in the introductory statement requested above.
In either case, the statement requested above should include any
proposed financial or managerial changes, such as changes in the
directorate or official staff, that will attend the transaction. If the
information required is provided in a related application, such
material may be incorporated by reference.

09/2011

FR 2083A
OMB Number 7100-0046
Approval expires December 31, 2022
Page 1 of 2

FOR USE BY STATE BANKS CONVERTING TO A STATE MEMBER BANK. NATIONAL
BANKS, WHICH ALREADY SUBSCRIBE TO FEDERAL RESERVE BANK STOCK, SHOULD
NOT COMPLETE THIS APPLICATION WHEN CONVERTING TO A STATE MEMBER BANK

Board of Governors of the Federal Reserve System

Application for Federal Reserve Bank Stock—FR 2083A

Date of Application:
Month / Day / Year

ABA Number:
Indicate whether total consolidated assets of the bank exceed $11.229 billion:
At a meeting of the

,

Governing Board

Yes

Corporate Title of Applying Bank

,

City or Town

called and held on the

Day

day of

No

Month

,

, duly

State

Year

, the following resolution was adopted:

"WHEREAS, it is the sense of this meeting that application should be made on behalf of this bank for membership in the Federal
Reserve System in accordance with the provisions of the Federal Reserve Act and the regulations of the Board of Governors of the
Federal Reserve System made pursuant thereto;
"WHEREAS, this bank reported on its most recent Report of Condition (or contemplates reporting after the formation, merger, or
consolidation on
) paid-up capital of $
, paid-up surplus of $
,
Date of Transaction

and1 a related equity adjustment of $

(if necessary) and;

"WHEREAS, under the provisions of the Federal Reserve Act, such a bank applying for membership in the Federal Reserve System is
required to subscribe to stock in a Federal Reserve Bank in a sum equal to six percent of the paid-up capital stock and surplus1 of such
applying bank;
"NOW, THEREFORE, BE IT RESOLVED, that the President, Chief Financial Officer or Vice President and the Cashier or Secretary of
this bank be and they are hereby authorized, empowered, and directed to make application for and to subscribe to the appropriate
number of shares, of a par value of $100 each, of the capital stock of the Federal Reserve Bank of
,
as determined on the basis of the capital stock and surplus, as defined in Regulation I, of this bank as of the date upon which its
membership in the Federal Reserve System becomes effective; to pay for2 such stock in accordance with the provisions of the Federal
Reserve Act; to agree for and in behalf of this bank that, upon its admission to membership in the Federal Reserve System, it will
comply with all the requirements of the Federal Reserve Act and the regulations of the Board of Governors of the Federal Reserve
System made pursuant to law that are applicable to state banks and trust companies which become members of the Federal Reserve
System; and to agree for and in behalf of this bank that reports and information regarding this bank may be interchanged between the
Federal Reserve Bank of
and all state or federal supervisory
authorities having jurisdiction of this bank."
1. In accordance with Regulation I, the capital stock and surplus of a member bank includes the paid-up capital stock and paid-up surplus of the bank (for
both common and preferred stock), less any net deficit amount reported by the bank on its report of condition as retained earnings and accumulated
other comprehensive income. This latter equity adjustment is made only if a net negative amount is to be reported for those two categories on the
bank's report of condition; otherwise no adjustment is necessary. In the case of a de novo bank, in order to avoid the necessity of making applications
for additional stock in the Federal Reserve Bank, as additional installments of the capital stock and surplus of the applying bank are paid in, application
may be made for stock in the Federal Reserve Bank in an amount equal to six percent of the authorized capital of the applyingbank plus six percent of
the amount of surplus, if any, which the subscribers to the capital stock of the applying bank have agreed to pay in.
2. One-half of the amount of the bank's subscription shall be paid to the Federal Reserve Bank and the remaining half will be subject to call when
deemed necessary by the Board of Governors of the Federal Reserve System.

01/2022

This application should be sent to the FEDERAL RESERVE BANK of your district.

01/2022

FR 2083A
Page 2 of 2

FOR USE BY STATE BANKS CONVERTING TO A STATE MEMBER BANK. NATIONAL
BANKS, WHICH ALREADY SUBSCRIBE TO FEDERAL RESERVE BANK STOCK, SHOULD
NOT COMPLETE THIS APPLICATION WHEN CONVERTING TO A STATE MEMBER BANK

ABA Number:
I hereby certify that the foregoing is a true and complete copy of a resolution duly adopted by the Board of Directors of this bank on the
date specified and still in full force and effect.

Cashier, Secretary, or Treasurer

,

Corporate Title of Applying Bank

Pursuant to the foregoing resolution,

City or Town

City or Town

,

State

,

Corporate Title of Applying Bank

,

, hereby makes application for and subscribes to
State

shares3 of the capital stock of the Federal Reserve Bank of
, of a par value of $100
each, as determined on the basis of the capital stock and surplus, as defined in Regulation I, of this bank as of the date upon which the
membership of this bank in the Federal Reserve System becomes effective; agrees to pay for the same in accordance with the provisions
of the Federal Reserve Act; agrees that, upon its admission to membership in the Federal Reserve System, it will comply with all the
requirements of the Federal Reserve Act and the regulations of the Board of Governors of the Federal Reserve System made pursuant to
law that are applicable to state banks and trust companies which become members of the Federal Reserve System; and agrees that
reports and information regarding this bank may be interchanged between the Federal Reserve Bank of
and all state or federal supervisory authorities having jurisdiction of this bank.
The required information, as indicated in the General Information and Instructions, is attached to and made a part of this application.

Corporate Title of Applying Bank

,

By

City or Town

,

State

President, Chief Financial Officer or Vice President

ATTEST:

Cashier, Secretary, or Treasurer

NOTE: One of the signers of the form must be listed on the bank's Official Authorization List (OAL) that is on file with the Federal Reserve
and hold one of the titles identified. It is recommended that banks periodically review and update this form. Instructions for submitting
Board Resolution and Authorized Approver packages are available online at https://www.frbservices.org/forms/accounting/index.html.
3. If six percent of the paid-up or authorized capital and surplus, whichever is adopted as the base of this application, amounts to a sum not divisible by
100, the bank should apply for one additional share of stock for any excess or fractional part of $100.

06/2019

FOR USE BY MUTUAL SAVINGS BANKS

FR 2083B
OMB Number 7100-0046
Approval expires December 31, 2022
Page 1 of 2

Board of Governors of the Federal Reserve System

Application for Federal Reserve Bank Stock—FR 2083B
Date of Application:
Month / Day / Year

ABA Number:
Indicate whether total consolidated assets of the bank exceed $11.229 billion:
At a meeting of the

,

Governing Board

Yes

Corporate Title of Applying Bank

,

City or Town

called and held on the

Day

day of

No

Month

, duly

State

,

Year

, the following resolution was adopted:

"WHEREAS, it is the sense of this meeting that application should be made on behalf of this bank for membership in the Federal
Reserve System in accordance with the provisions of the Federal Reserve Act and the regulations of the Board of Governors of the
Federal Reserve System made pursuant thereto;
"WHEREAS, this bank reported on its most recent Report of Condition (or contemplates reporting after the formation, merger, or
consolidation on
) total deposit liabilities of $
; and (check one)
Date of Transaction

Mutual savings banks authorized to purchase Federal Reserve Bank stock.¹
"WHEREAS, under the provisions of the Federal Reserve Act, such a bank applying for membership in the Federal Reserve System is
required to subscribe to capital stock in the Federal Reserve Bank in an amount equal to six-tenths of one percent of its total deposit liabilities as reported on the bank's most recent Report of Condition (or as reported above) and as permitted by the laws under which it
was organized;
Mutual savings banks not authorized to purchase Federal Reserve Bank stock.
"WHEREAS, this bank is not permitted by the laws under which it was organized to purchase stock in a Federal Reserve Bank; and
“WHEREAS, such a bank applying for membership in the Federal Reserve System is required, upon admission to the System, to
deposit with the Federal Reserve Bank an amount equal to the amount which it would have been required to pay in on account of a
subscription to capital stock of the Federal Reserve Bank if authorized to purchase such stock;
“NOW, THEREFORE, BE IT RESOLVED, that the President, Chief Financial Officer or Vice President and the Treasurer, Cashier, or
Secretary of this bank be and they are hereby authorized, empowered, and directed to make application for and to subscribe to the
appropriate number of shares, of a par value of $100 each, of the capital stock of or, in the case of a mutual savings bank not authorized to
purchase Federal Reserve Bank stock, application for permission to deposit the appropriate amount with, the Federal Reserve Bank of
, as determined on the basis of the total deposit liabilities of this bank as reported on the
bank's most recent Report of Condition (or as reported above); to pay for2 such stock or deposit in accordance with the provisions
of the Federal Reserve Act; to agree for and in behalf of this bank that, upon its admission to membership in the Federal Reserve
System, it will comply with all the requirements of the Federal Reserve Act and the regulations of the Board of Governors of the
Federal Reserve System made pursuant to law that are applicable to mutual savings banks which become members of the
Federal Reserve System; and to agree for and in behalf of this bank that reports and information regarding this bank may be
interchanged between the Federal Reserve Bank of
and all state or federal
supervisory authorities having jurisdiction of this bank."

1. Including mutual savings banks previously admitted to membership.
2. One-half of the amount of the bank’s subscription shall be paid to the Federal Reserve Bank and the remaining half will be subject to call when

01/2022

deemed necessary by the Board of Governors of the Federal Reserve System.

This application should be sent to the FEDERAL RESERVE BANK of your district.

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FOR USE BY MUTUAL SAVINGS BANKS

FR 2083B
Page 2 of 2

ABA Number:
I hereby certify that the foregoing is a true and complete copy of a resolution duly adopted by the
of this bank on the date specified and still in full force and effect.

Governing Board

Cashier, Secretary, or Treasurer

,

Corporate Title of Applying Bank

City or Town

,

State

,

Pursuant to the foregoing resolution,
Corporate Title of Applying Bank

,
City or Town

State

, hereby makes application for

shares,3

of a par value of $100 each, of the capital stock of (or, in the case of a mutual savings bank not authorized to purchase Federal Reserve Bank
stock, application for permission to deposit the appropriate amount with) the Federal Reserve Bank of
,
as determined on the basis of the total deposits liabilities of this bank as reported on the bank's most recent Report of Condition (or as
reported above); agrees to pay for the same in accordance with the provisions of the Federal Reserve Act; agrees that, upon its
admission to membership in the Federal Reserve System, it will comply with all the requirements of the Federal Reserve Act and the
regulations of the Board of Governors of the Federal Reserve System made pursuant to law which are applicable to mutual savings
banks which become members of the Federal Reserve System; and agrees that reports and information regarding this bank may be
interchanged between the Federal Reserve Bank of
and all state or federal supervisory authorities
having jurisdiction of this bank.
The required information, as indicated in the General Information and Instructions, is attached to and made a part of this application.
,
Corporate Title of Applying Bank

,
City or Town

By

State

President, Chief Financial Officer or Vice President

ATTEST:

Cashier, Secretary, or Treasurer

NOTE: One of the signers of the form must be listed on the bank's Official Authorization List (OAL) that is on file with the Federal Reserve
and hold one of the titles identified. It is recommended that banks periodically review and update this form. Instructions for submitting
Board Resolution and Authorized Approver packages are available online at https://www.frbservices.org/forms/accounting/index.html.
3. If six-tenths of one percent of total deposit liabilities amounts to a sum not divisible by 100, the bank should apply for one additional share of stock for
any excess or fractional part of $100.

06/2019

FR 2083C
OMB Number 7100-0046
Approval expires December 31, 2022
Page 1 of 2

Board of Governors of the Federal Reserve System

Certificate of Organizers or of Directors1—FR 2083C

We, the undersigned directors (or organization committee) of the

City or Town

,

Corporate Title of Applying Bank

, certify, to the best of our knowledge and belief,

State

that the required information submitted herewith contains a true and complete statement of the actual (or anticipated in the case of a
new bank) condition of this bank on the date(s) specified; that such statement includes all of the assets and liabilities of the bank; that
the capital stock and surplus, as defined in Regulation I, is unimpaired (this clause does not apply to mutual savings banks); and that
the supplemental information submitted with and made a part of the application of this bank for membership in the Federal Reserve
System is true to the best of our knowledge and belief.

Name

Date (MM/DD/YYYY)

Name

Date (MM/DD/YYYY)

Name

Date (MM/DD/YYYY)

Name

Date (MM/DD/YYYY)

Name

Date (MM/DD/YYYY)

Name

Date (MM/DD/YYYY)

Name

Date (MM/DD/YYYY)

1. Should be signed by all directors (except directors who have previously signed as organizers), and may be executed in counterparts. Type name
under each signature. If a new bank is involved and officers and directors have not yet been elected, this form should be signed by the members of the
organizaionorganization committee. If the signers have any reservation as to any of the clauses in the certificate, an explanation similarly signed
should be attached to this sheet.

12/2019

FR 2083C
Page 2 of 2

(This page will be moving after Page 1)
Filing Certification
The completed application must be submitted to the appropriate Reserve Bank with the following certification, signed and dated by an
authorized official of the proposed member bank:
I certify that the information contained in this application has been examined carefully by me and is true, correct, and complete, and is
current as of the date of this submission to the best of my knowledge and belief. I acknowledge that any misrepresentation or omission
of a material fact constitutes fraud in the inducement and may subject me to legal sanctions provided by 18 U.S.C. §§ 1001 and 1007.
I also certify, with respect to any information pertaining to an individual and submitted to the Board in (or in connection with) this
application, that the Applicant has the authority, on behalf of the individual, to provide such information to the Board and to consent or to
object to public release of such information. I certify that the Applicant and the involved individual consent to public release of any such
information, except to the extent set forth in a written request by the Applicant or the individual, submitted in accordance with the
Instructions to this form and the Board's Rules Regarding Availability of Information (12 C.F.R. Part 261), requesting confidential
treatment for the information.
I request that examiners be assigned to make any investigations necessary.
I acknowledge that approval of this application is in the discretion of the Board of Governors of the Federal Reserve System. Actions or
communications, whether oral, written, or electronic, by the Federal Reserve or its employees in connection with this filing, including
approval if granted, do not constitute a contract, either express or implied, or any other obligation binding upon the agency, the United
States or any other entity of the United States, or any officer or employee of the United States. Such actions or communications will not
affect the ability of the Federal Reserve to exercise its supervisory, regulatory, or examination powers under applicable laws and
regulations. I further acknowledge that the foregoing may not be waived or modified by any employee or agency of the Federal
Reserve or of the United States.

Name

Date (MM/DD/YYYY)

06/2019