Interagency Biographical And Financial Report {FDIC 3064-0006}

OMB No. for FDIC 3064-0006 OMB No. for FRB 7100-0134 OMB No. for OCC 1557-0014 OMB Nos. for OTS 1550-0005, -0015, -0047 Expiration Date: 04/30/2017 INTERAGENCY BIOGRAPHICAL AND FINANCIAL REPORT Public reporting burden for this collection of inform ation is estimated to average two hours forbiographical information and two hours for financial inform ation. This estimate includes time to gather and m aintain data in the required form to , review instructions, and to 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: Paperwork Reduction Act, Legal Division, Federal Deposit Insurance Corporation, 550 17th Street, NW, Washington, DC 20429; Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, NW , W ashington, DC 20551; Licensing Activities Division, Comptroller of the Currency, 250 E Street S.W., Washington, DC 20219; or Office of Supervision , Policy, Office of Thrift Supervision, 1700 G Street, N.W., Washington, DC 20552; and to the Office of Management and Budget, Paperwork Reduction Project, Washington, DC 20503. An organization or a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. GENERAL INFORMATION AND INSTRUCTIONS This Interagency Biographical and Financial Report (report) is used by individuals1 in conjunction with other corporate filings to the appropriate regulatory agency. This report is not a stand-alone document. Preparation Use of this report format is not mandatory. If an alternative format is used, it must provide all requested information, including the certification. 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" or "yes" should be explained. The questions are not intended to limit the presentation nor are the questions intended to duplicate information supplied on another form or in an exhibit. For example, 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 located easily. Use additional sheets as necessary. Each regulatory agency will provide additional instructions for use and preparation. If the report is not complete, the regulatory agency may either request additional information or return the filing. If you are a foreign national or a United States citizen who currently resides in a foreign country, additional information may be necessary. Financial statements from individuals must have "as of" dates of not more than 90 days prior to the date the financial report is submitted. All amounts in this report must be based on current 1 A company seeking to acquire direct or indirect control of a bank or thrift should consult with the appropriate regulatory agency for filing instructions. i American LegalNet, Inc. www.FormsWorkFlow.com market value in United States dollars2 and agree with any totals in the supplementary schedules. In addition to the sample financial schedules, you may wish to provide supplementary schedules for other items on the financial statement. If the sample financial statement is used, an answer is required to each item. If you submit an alternative Financial Report format, the information must respond to each request for information contained in the sample Financial Report. In addition, each regulatory agency specifically reserves the right to require up to five years of financial data from any acquiring person as well as the filing of additional information and/or statements, such as a federal income tax return or a current appraisal to support an asset's value. If you have been convicted of any criminal offense involving dishonesty, breach of trust, or money laundering, or have agreed to enter into a pretrial diversion or similar program in connection with a prosecution of such offense (12 U.S.C. § 1829), you must obtain approval from the FDIC before you can own, control, participate in the affairs of, or become an institution-affiliated party of a depository institution. Each individual must report promptly any material change in the biographical report or financial condition that occurs during the review period for the filing. For additional information regarding the processing procedures and guidelines and any supplemental information that may be required, refer to the appropriate regulatory agency's procedural guidelines (that is, the Comptroller's Licensing Manual, the FDIC's Rules and Regulations (12 C.F.R. Part 303), or the OTS' Application Processing Handbook), contact the agency directly for specific instruction, or visit its Web site at www.occ.treas.gov, www.fdic.gov, www.ots.treas.gov, or www.federalreserve.gov. Definitions For purposes of this document: Affiliate means any company that owns or controls, is owned or controlled by, or is under common ownership or control with a depository institution or depository institution holding company. Associated means associated as an officer, director, organizer, partner, trustee, or principal shareholder or owner. Company means any corporation, association, partnership, limited liability company, business trust, sole proprietorship, joint venture, or other similar organization. Depository institution means any bank (including a national, state, district, or foreign bank), savings association, savings bank, savings and loan association, building and loan association, homestead association, cooperative bank, trust company, industrial bank or loan company, or 2 Provide the foreign currency exchange rate and conversion date, if applicable. ii American LegalNet, Inc. www.FormsWorkFlow.com credit union. A United States office, including a branch or agency, of a foreign bank is a depository institution. Management official includes a senior executive officer; director; advisory or honorary director of a depository institution with total assets of $100 m illion or m ore; branch m anager; trustee of a depository organization under the control of trustees; and any person who has a representative or nominee serving in any of those capacities. Principal shareholder or owner means a person who directly or indirectly owns, controls, or holds (either individually or as a member of a group) the power to vote 10 perc