APPLICATION TO ESTABLISH
A CREDIT UNION BRANCH OFFICE
(O.A.C. § 180:10-1-17)
OKLAHOMA STATE BANKING DEPARTMENT
2900 N. LINCOLN BLVD.
OKLAHOMA CITY, OKLAHOMA 73105
Name of Applicant
Address (Main Office)
Street
City
State
Zip
Date of Application
REQUESTS FOR ADDITIONAL INFORMATION OR OTHER COMMUNICATIONS
ABOUT THIS APPLICATION SHOULD BE DIRECTED TO:
Name
Title
Address (Main Office)
Street
City
State
Zip
Telephone Number (
)
Fax Number (
)
E-mail Address
22525-54
Date of Form: Oct. 2016
APPLICATION TO ESTABLISH
A CREDIT UNION BRANCH OFFICE
(O.A.C. § 180:10-1-17)
OKLAHOMA STATE BANKING DEPARTMENT
2900 N. LINCOLN BLVD.
OKLAHOMA CITY, OKLAHOMA 73105
Name of Applicant
Address (Main Office)
Street
City
State
Zip
Date of Application
REQUESTS FOR ADDITIONAL INFORMATION OR OTHER COMMUNICATIONS
ABOUT THIS APPLICATION SHOULD BE DIRECTED TO:
Name
Title
Address (Main Office)
Street
City
State
Zip
Telephone Number (
)
Fax Number (
)
E-mail Address
22525-54
Date of Form: Oct. 2016
Answer all parts of this application. If additional space is needed, please supplement with
additional pages and with a clear reference in the space provided to the supplemental page(s).
If any part of the application does not apply, write “n/a”.
Location of Current and Proposed Facilities
1.
Address of proposed branch:
Street
City
Zip
2.
Distance of proposed branch from main office:
.
3.
Address(es) of existing branches (attach additional pages, if necessary):
Street
City
Zip
Street
City
Zip
Street
City
Zip
4.
Will the branch be a shared branch? Yes
No
. If yes, list other Oklahoma
institutions that will share the branch.
.
Investment in Fixed Assets
5.
Describe how the credit union intends to finance the cost of the proposed branch. If a loan
is involved, provide details.
6.
Will the credit union own or lease the proposed branch location?
7.
If the credit union will own the proposed branch location, will the credit union lease any
other portion of the facility to other tenants? Yes
No
If yes, what is the percentage of total building space to be leased to others?
8.
Current total assets of the credit union (as of most recent report of condition, i.e., Call
Report): $
9.
Current book value of all real estate, buildings, fixtures, equipment, furniture and
furnishings (“Fixed Assets”) of the credit union (excluding proposed branch facility)
$
2
22525-54
Date of Form: Oct. 2016
10.
Estimated value of fixed assets associated with proposed branch:$
11.
Will the projected cost of the facility result in an investment in fixed assets that exceeds the
limits of Title 6 O.S. Section 2006(4)?
Yes
No
If yes, will the projected cost of the facility result in an investment in fixed assets that
exceeds any additional limitation imposed by the State Credit Union Board?
Yes
No
Field of Membership
 Single Common Bond
 Multiple Common Bond
 Community
12.
Current number of (a) primary members:
(b) potential members:
13.
Estimated number of current members that will use branch facility:
14.
Estimated number of members to be gained by opening the proposed branch:
Branch Operation
15.
Total staff needed to operate branch:
New hires:
Main office transfers:
16.
Monthly increase in salaries for new employees (estimated):$
17.
Hours of operation for proposed branch:
18.
Services to be offered at proposed branch:
19.
In the space below, please describe those factors that were considered by
management in deciding to establish the proposed branch:
20.
Interstate Branch Establishment - If the proposed branch will be established in
another state, in the space below or in an attachment, indicate how the proposal
complies with applicable state and federal laws governing the establishment of
interstate branches.
Also, attach a copy of current host state law relating to interstate branching.
3
22525-54
Date of Form: Oct. 2016
21.
Additional comments by applicant, if any:
Please submit the original and 2 copies of this Application along with a check in the amount of
$400 payable to the “Oklahoma State Banking Department” to:
Oklahoma State Banking Department
2900 N. Lincoln Blvd.
Oklahoma City, Oklahoma 73105
Printed Name
Signature
Title (must be President or Manager)
4
22525-54
Date of Form: Oct. 2016