Public Information:

Bank Name: _______________________________

Charter: ________________

Please note the following reporting requirements for Independent Credit Card Banks:

Currently receivables attributable (as defined below) is not a separately reported amount included in the regular quarterly call report. In order to comply with the independent credit card assessment that applies to this component, it is necessary for you to provide the following information.

Total off balance sheet receivables attributable ( $ in millions) to credit card accounts owned by your institution as of the most recent December 31 or June 30 call date. If there are no receivables that meet this requirement, please indicate NONE.

__________________________________________ ($ in millions)

Signed Name: ________________________________ Phone Number ________________

Printed name: _________________________________

Please FAX this completed form to: Bank Assessments at (301) 433-6178. This information is due 30 days prior to each semiannual assessment payment date.

Receivables attributable is the total amount of outstanding balances due on credit card accounts owned by an independent credit card bank (the receivables attributable to those accounts) on the last day of the assessment period, minus receivables retained on the bank's balance sheet as of that day.

For specific questions concerning assessments, please call our 24-hour, toll free number at 866-874-5150 or 202-874-5150. Leave a detailed message and a staff member will return your call promptly.

The Office of the Comptroller of the Currency was created by Congress to charter national banks, to oversee a nationwide system of banking institutions, and to assure that national banks are safe and sound, competitive and profitable, and capable of serving in the best possible manner the banking needs of their customers.