Application to Establish a Credit Union Branch - Idaho

This printable "Application to Establish a Credit Union Branch" is a document issued by the Idaho Department of Finance specifically for Idaho residents.

Download a PDF of the latest edition of the form down below or find it through the department's forms library.

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1
FINANCIAL INSTITUTIONS BUREAU
Bureau Chief – Mary E. Hughes
800 Park Blvd, Suite 200, Boise, ID 83712
Mail To: P.O. Box 83720, Boise ID 83720-0031
Phone: (208) 332-8005 Fax: (208) 332-8098
http://finance.idaho.gov
PROTECTING THE INTEGRITY OF IDAHO FINANCIAL MARKETS SINCE 1905
________________________________________________________________________________________________
STATE CREDIT UNION
APPLICATION TO ESTABLISH A CREDIT UNION BRANCH
APPLICANT CREDIT UNION
Name of Credit Union:________________________________________________________________________________
Address of Credit Union:_______________________________________________________________________________
City:_______________________________ State: __________________ Zip Code:_____________________________
Name & Title of Contact Person:________________________________________________________________________
Address (if different from above):_______________________________________________________________________
City:_______________________________ State:___________________ Zip Code:_____________________________
Telephone Number:__________________________________________________________________________________
BRANCH OFFICE DATA
On a separate page please submit the following information as part of your application for a branch office of your credit
union:
 Reason for the request. The credit union must justify that ninety per cent (90%) of the cost of the branch and its
operation will be derived from existing and potential membership in the proposed area.
 Description of services to be provided at the proposed branch.
 Proposed location of branch office.
 Estimated number of members the branch will serve.
 Distance and geographical direction to proposed branch from the head office.
 Information to support the opinion there is a member need for the proposed branch in the area.
 A physical description of the quarters to be occupied by the branch.
 If the property is to be purchased, information as to the estimated cost.
 If the property is to be leased, information as to the terms of the proposed lease and the estimated improvement
costs, if any, to be incurred by the lessee.
 Description of vault, furniture, fixtures, and equipment for the proposed branch, along with projection of their cost. If
complete building plans have not been formulated for the branch, limits should be set on the expected investment in
building, leasehold improvements, furniture, fixtures, and equipment.
1
FINANCIAL INSTITUTIONS BUREAU
Bureau Chief – Mary E. Hughes
800 Park Blvd, Suite 200, Boise, ID 83712
Mail To: P.O. Box 83720, Boise ID 83720-0031
Phone: (208) 332-8005 Fax: (208) 332-8098
http://finance.idaho.gov
PROTECTING THE INTEGRITY OF IDAHO FINANCIAL MARKETS SINCE 1905
________________________________________________________________________________________________
STATE CREDIT UNION
APPLICATION TO ESTABLISH A CREDIT UNION BRANCH
APPLICANT CREDIT UNION
Name of Credit Union:________________________________________________________________________________
Address of Credit Union:_______________________________________________________________________________
City:_______________________________ State: __________________ Zip Code:_____________________________
Name & Title of Contact Person:________________________________________________________________________
Address (if different from above):_______________________________________________________________________
City:_______________________________ State:___________________ Zip Code:_____________________________
Telephone Number:__________________________________________________________________________________
BRANCH OFFICE DATA
On a separate page please submit the following information as part of your application for a branch office of your credit
union:
 Reason for the request. The credit union must justify that ninety per cent (90%) of the cost of the branch and its
operation will be derived from existing and potential membership in the proposed area.
 Description of services to be provided at the proposed branch.
 Proposed location of branch office.
 Estimated number of members the branch will serve.
 Distance and geographical direction to proposed branch from the head office.
 Information to support the opinion there is a member need for the proposed branch in the area.
 A physical description of the quarters to be occupied by the branch.
 If the property is to be purchased, information as to the estimated cost.
 If the property is to be leased, information as to the terms of the proposed lease and the estimated improvement
costs, if any, to be incurred by the lessee.
 Description of vault, furniture, fixtures, and equipment for the proposed branch, along with projection of their cost. If
complete building plans have not been formulated for the branch, limits should be set on the expected investment in
building, leasehold improvements, furniture, fixtures, and equipment.
2
 Proposed opening date of the branch.
 Approximate annual cost of operating the branch.
 Impact proposed branch office will have on head office (indicate the credit union’s fixed asset investment).
 Plans for staffing the proposed branch. Submit a resume of the proposed branch manager and indicate the number
and experience level of subordinate personnel.
 Most recent month-end financial statements (include income and expenses).
 An estimate of shares and loans for the first three years at the proposed branch. (See attached sample 3 year pro
forma statement)
 An estimate of income and expenses for the first three years at the proposed branch. (See attached sample 3 year pro
forma statement)
BOARD APPROVAL
The Idaho Credit Union Act § 26-2116(i) establishes a special duty of the Board of Directors to authorize the conveyance
of property. Please certify by checking below that the Board of Directors has approved any purchase or sale of real
property related to the proposed branch:
 The Board of Directors has authorized all purchases or sales of real property related to this proposed branch.
__________________________________________________________________________________________________________
3
SAMPLE PRO FORMA STATEMENT
Year 1
Year 2
Year 3
Estimate
Estimate
Estimate
Income
Interest from Loans
$
-
$
-
$
-
Investment Income
$
-
$
-
$
-
Other Income
$
-
$
-
$
-
Total Income
$
-
$
-
$
-
Expenses
Salaries, Wages, and
Benefits
$
-
$
-
$
-
Travel and Conference
$
-
$
-
$
-
Office Occupancy
$
-
$
-
$
-
Office Operations
$
-
$
-
$
-
Education and Promotion
$
-
$
-
$
-
Loan Servicing
$
-
$
-
$
-
Other
$
-
$
-
$
-
Interest Expense
$
-
$
-
$
-
Total Expenses
$
-
$
-
$
-
Net Gain or Loss
$
-
$
-
$
-
Total Loans Outstanding
$
-
$
-
$
-
Total Shares
$
-
$
-
$
-
Total Assets
$
-
$
-
$
-
Total Members
#
#
#

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