"Application to Form a State-Chartered Credit Union" - Tennessee

This Tennessee-specific "Application to Form a State-Chartered Credit Union" is a document released by the Tennessee Department of Financial Institutions.

Download the fillable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Download "Application to Form a State-Chartered Credit Union" - Tennessee

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APPLICATION TO FORM A STATE-CHARTERED CREDIT UNION
The undersigned natural persons make this application to form a state-chartered
credit union and affirm that the following information is correct to the best of our
knowledge and belief.
PROPOSED NAME: _____________________________________ CREDIT UNION
ALTERNATE NAME IF FIRST CHOICE IS UNAVAILABLE:
________________________________________________________ CREDIT UNION
COMMON BOND:
There is a common bond of:
_________________ EMPLOYMENT (State type of business, name(s) of business/
businesses, location/mailing address of business, key officer of
business.)
_________________ MEMBERSHIP (State type of association, name of association,
location/mailing address of association, key officer of
association.)
COMMUNITY (State name of community and location.)
____________________
_________________ Does the credit union request designation as a low-income
credit union?
APPLICATION TO FORM A STATE-CHARTERED CREDIT UNION
The undersigned natural persons make this application to form a state-chartered
credit union and affirm that the following information is correct to the best of our
knowledge and belief.
PROPOSED NAME: _____________________________________ CREDIT UNION
ALTERNATE NAME IF FIRST CHOICE IS UNAVAILABLE:
________________________________________________________ CREDIT UNION
COMMON BOND:
There is a common bond of:
_________________ EMPLOYMENT (State type of business, name(s) of business/
businesses, location/mailing address of business, key officer of
business.)
_________________ MEMBERSHIP (State type of association, name of association,
location/mailing address of association, key officer of
association.)
COMMUNITY (State name of community and location.)
____________________
_________________ Does the credit union request designation as a low-income
credit union?
MEMBERSHIP/ORGANIZATION:
1.
The potential number of members of the proposed CREDIT UNION is: _________
2.
Where do the potential members live? ______________________________________
_______________________________________________________________________
_______________________________________________________________________
3.
If the potential members to be served by the CREDIT UNION work in more than
one location or city, please designate:
a.
Number of employees at each location: _______________________________
_________________________________________________________________
_________________________________________________________________
b.
How CREDIT UNION business will be transacted with outlying groups of
members: ________________________________________________________
_________________________________________________________________
_________________________________________________________________
c.
Why it is proposed to organize one CREDIT UNION for the entire group:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
4.
Is CREDIT UNION service now available to any members of the proposed
membership from either a state or federal credit union? If so, please designate the
names and locations of these credit union: __________________________________
_______________________________________________________________________
_______________________________________________________________________
5.
If the proposed CREDIT UNION will serve a business firm, does company
management approve of the CREDIT UNION being organized? ________________
NAME AND TITLE OF OFFICIALS APPROVING CREDIT UNION:
__________________________________ ___________________________________
NAME
TITLE
__________________________________ ___________________________________
NAME
TITLE
Please attach a letter from the employer requesting CREDIT UNION service.
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6.
What facilities, if any, will the employer provide:
_____________ Payroll Deduction
_____________ Office Space
_____________ Clerical Assistance
_____________ Other (explain): ___________________________________________
_______________________________________________________________________
7.
If the CREDIT UNION cannot operate on the employers property, explain how it
will be able to transact business effectively with members.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
8.
Will the CREDIT UNION have a sponsor (such as a director or member of a
successfully operated credit union who will assist the new organization in getting
started?)
NAME OF SPONSORING CREDIT UNION/INDIVIDUAL: __________________
_______________________________________________________________________
_______________________________________________________________________
9.
Name and Social Security Number of proposed manager. Please attach resume.
_______________________________________________________________________
Name
SSN
10.
If the CREDIT UNION will be designated as a low-income credit union, provide
documentation that a majority of the members will be low-income members.
(NOTE: A credit union that serves a geographic area where a majority of residents
fall at or below the annual income standard is presumed to be serving
predominantly low-income members.):
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
SHARE INSURANCE:
1.
Has application been made for share insurance at date of this application? _______
If so, attach copy of application.
3
POLICIES/PROCEDURES:
1.
Please attach the following written policies:
_____________ Loan Policy
_____________ Investment Policy
_____________ Share Policy
_____________ Funds Management Policy
_____________ Compliance Policy
2.
Please attach proposed By-laws for the CREDIT UNION.
3.
Please attach a proposed BUDGET for the first year of operation.
4.
Please attach financial projection for the first five (5) years of operation of the
CREDIT UNION.
5.
If the CREDIT UNION will lease office space, please provide a copy of the lease.
6.
Please attach a copy of the proposed charter of the credit union.
PROPOSED OPENING DATE:
The desired or proposed opening date for the CREDIT UNION is:
_____________________________________, _________.
PLEASE PROVIDE ANY ADDITIONAL COMMENTS BELOW WHICH WILL ASSIST
THE COMMISSIONER IN A FAVORABLE CONSIDERATION OF THIS
APPLICATION.
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ORGANIZERS:
TYPED NAME/
SIGNATURE/
SOCIAL
SECURITY #
TYPED NAME/
SIGNATURE/
SOCIAL
SECURITY #
TYPED NAME/
SIGNATURE/
SOCIAL
SECURITY#
TYPED NAME/
SIGNATURE/
SOCIAL
SECURITY #
TYPED NAME/
SIGNATURE/
SOCIAL
SECURITY #
TYPED NAME/
SIGNATURE/
SOCIAL
SECURITY#
TYPED NAME/
SIGNATURE/
SOCIAL
SECURITY #
TYPED NAME/
SIGNATURE/
SOCIAL
SECURITY#
PERSON TO WHOM CORRESPONDENCE REGARDING THIS APPLICATION MAY
BE SENT:
_______________________________________________
TYPED NAME
_______________________________________________
MAILING ADDRESS
_______________________________________________
DAY-TIME TELEPHONE NUMBER
DATE OF APPLICATION: ____________________________________________________
Email ADDRESS: _________________________________________
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