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Forms
FDIC, interagency and Federal Financial Institutions Examination Council forms for applications, reports, doing business with the FDIC, and other administrative matters:  
 
FDIC & Interagency Forms
Bank Supervision
  - Applications
  - Reports & Notices
Deposit Claims & Asset Sales
Doing Business with the FDIC
  - Contracting & Leasing
  - Financial Management
  - Leasing
  - Legal Services
Personnel Administration
FFIEC Forms
Federal Financial Institutions Examination Council
Forms at the FFIEC website.

The forms are Adobe® PDF file or Microsoft® Word files. Information on downloading and using these files is at: PDF Help & Word Help.

Bank Supervision - Applications

Form Title Form Number File size
Application for Consent to Exercise Trust Powers
    Adobe® PDF file
    Microsoft® Word file
FDIC 6200/09
183 kb
  91 kb
Form 3: Initial Statement of Beneficial Ownership of Securities (Formerly Form F-7)
    Adobe® PDF file
    Microsoft® Word file
    •   Form 3 Instructions
FDIC 6800/03
 


379 kb
140 kb
  57 kb
 
Form 4: Statement of Changes in Beneficial Ownership of Securities (Formerly Form F-8)
   
Adobe® PDF file
    Microsoft® Word file
    •   Form 4 Instructions
FDIC 6800/04
 
274 kb
240 kb
  62 kb
 
Form 5: Annual Statement of Beneficial Ownership of Securities (Formerly Form F-8A)
   
Adobe® PDF file
    Microsoft® Word file
    •  
Form 5 Instructions
 
 FDIC 6800/05  

260 kb
189 kb
  66 kb
Interagency Bank Merger Act Application
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 3064-0015  
116 kb
111 kb
Interagency Charter and Federal Deposit Insurance Application
    Adobe® PDF file
   
Microsoft® Word file
 
FDIC 3064-0001  
226 kb
586 kb
Loan/Application Register (Formerly FDIC 6440/12)
   
Adobe® PDF file
    Microsoft® Word file 
   
 
  55 kb
  47 kb

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Bank Supervision - Reports & Notices

Form Title Form Number File size
Interagency Biographical and Financial Report
   
Adobe® PDF file
    Microsoft® Word file
   

FDIC 3064-0006


 160 kb
444 kb

Interagency Notice of Change in Control
    Adobe® PDF file
   
Microsoft® Word file
 
FDIC 3064-0019  
   133 kb
  213 kb
Interagency Notice of Change in Director of Senior Executive Officer
    Adobe® PDF file
 
FDIC 3064-0097  
  144 kb
Notice and Authorization Pertaining to Consumer Reports Pursuant to the Fair Credit Reporting Act of 1970, 15 U.S.C. § 1681, et seq.
    Adobe® PDF file
   
Microsoft® Word file
 
FDIC 1600/10
 
  44 kb
  34 kb
Notice by Financial Institutions of Government Securities Broker or Government Securities Dealer Activities
    Adobe® PDF file
 
G-FIN  

  28 kb
Notice by Financial Institutions of Termination of Activities as a Government Securities Broker or Government Securities Dealer
    Adobe® PDF file
 
G-FINW
 
  20 kb
Notification of Performance of Bank Services
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 6120/06  
1351 kb
   54 kb
Registered Transfer Agents  
Form for Registrations and Updating Amendments
    Adobe® PDF file
 
Form TA-1 

320 kb
Uniform Application for Municipal Securities Principal or Municipal Securities Representative Associated With a Bank Municipal Securities Dealer
    Adobe® PDF file
 
MSD-4


  900 kb
Uniform Termination Notice for Municipal Securities Principal or Municipal Securities Representative Associated with a Bank Municipal Securities Dealer
    Adobe® PDF file
 
MSD-5


 450 kb
Uniform Termination Notice for Person Associated with a Financial Institution Government Securities Broker or Dealer
    Adobe® PDF file
 
GFIN-5  

112 kb
Summary of Deposits
 

External Link

Suspicious Activity Report
    Adobe® PDF file
    Microsoft® Word file
 

FDIC 6710/06

 
153 kb
 200 kb

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Deposit Claims & Asset Sales
 

Form Title Form Number File size
Declaration for Custodian Deposit
    Adobe® PDF file
    Microsoft® Word file  
 
FDIC 7200/13
 

41 kb

65 kb
Declaration for Defined Benefit Plan
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 7200/12
 73 kb
48 kb
Declaration for Defined Contribution Plan
    Adobe® PDF file
    Microsoft® Word file  
 
FDIC 7200/10
 85 kb
58 kb
Declaration for Health and Welfare Plan
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 7200/14  
73 kb
 42 kb
Declaration for IRA/KEOGH Deposit
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 7200/11   
  71 kb
  44 kb
Declaration of Independent Activity
    Adobe® PDF file
    Microsoft® Word file  
 
FDIC 7200/06  
117 kb
  57 kb
Declaration of Independent Activity for Unincorporated Association
    Adobe® PDF file
    Microsoft® Word file  
 
FDIC 7200/07  
  70 kb
  59 kb
Declaration for Joint Ownership Deposit
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 7200/08 
  76 kb
  55 kb
Declaration for Plan and Trust
    Adobe® PDF file
    Microsoft® Word file 
 
FDIC 7200/15
  72 kb
  47 kb
Declaration for Power of Attorney
    Adobe® PDF file
    Microsoft® Word file
 
 FDIC 7200/16
  45 kb
  35 kb
Declaration for Public Unit Deposit
    Adobe® PDF file
    Microsoft® Word file
 
 FDIC 7200/04   
   78 kb
   54 kb
Declaration for Testamentary Deposit (Multiple Grantors)
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 7200/09 
 
 
  75 kb
  70 kb
Declaration for Testamentary Deposit (Single Grantor)
    Adobe® PDF file
    Microsoft® Word file  
 
FDIC 7200/03  
  60 kb
  47 kb
Declaration for Trust
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 7200/05
  66 kb
  73 kb
Power of Attorney
    Adobe® PDF file
    Microsoft® Word file
 
 
FDIC 7200/17  
  39 kb
  41 kb
Purchaser Eligibility Certification
    Adobe® PDF file
    Microsoft® Word file


The Purchaser Eligibility Certification for a specific sale will be available on the website of the loan sale adviser responsible for that sale. Purchasers will complete that form and provide it to the loan sale adviser. In order to self screen, Potential Purchasers can review this sample copy of the Purchaser Eligibility Certification.

 
 FDIC 7300/06  
117 kb
  57 kb

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 Doing Business with the FDIC - Contracting and Leasing

Form Title Form Number File size
Background Investigation Questionnaire for Contractor Personnel & Subcontractors
    Adobe® PDF file
    Microsoft® Word file
 
 FDIC 1600/04  

417 kb
  94 kb
Background Investigation Questionnaire For Contractors
    Adobe® PDF file
    Microsoft® Word file
 
 FDIC 1600/07  
  63 kb
  60 kb

Confidentiality Agreement for Contractors

    Microsoft® Word file
 

FDIC 3700/46   
 37 kb
Confidentiality Agreement for Contractor Personnel
   
Microsoft® Word file
 
FDIC 3700/46A 34 kb
Cover and Signature Pages
    Microsoft® Word file
 
 
  21 kb

FDIC Integrity and Fitness Representations and Certifications

    Adobe® PDF file
    Microsoft® Word file  
 

FDIC 3700/12
163 kb
183 kb

FDIC Leasing Representations and Certifications

    Adobe® PDF file
    Microsoft® Word file
 

FDIC 3700/44
209 kb
205 kb
FDIC Contractor Representations and Certifications
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 3700/04A  
245 kb
137 kb

Notice and Authorization Pertaining to Consumer Reports

    Adobe® PDF file
    Microsoft® Word file
 

FDIC 1600/10  
35 kb
100 kb
Part 366 - Minimum Standards of Integrity and Fitness for an FDIC Contract
   
 Microsoft® Word file 
 
 

67 kb
 
Payee Information for Automatic Deposit of Payment
    Adobe® PDF file
    Microsoft® Word file  
 
FDIC 4531/09  
105 kb
  57 kb
Request for Taxpayer Identification Number & Certification
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 4531/10
  52 kb
  80 kb
Voluntary Product Accessibility Template (VPAT)

External Link

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Doing Business with the FDIC - Financial Management

Form Title Form Number File size
Payee Information for Automatic Deposit of Payment
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 4531/09  
105 kb
 57 kb
Substitute Form W9, Request for Taxpayer Identification Number and Certification
    Adobe® PDF file
    Microsoft® Word file

 
FDIC 4531/10
  52 kb
  80 kb

 

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Doing Business with the FDIC - Legal Services

Form Title Form Number File size
Agreement for Services (Expert/Legal Support Services (LSS) Provider) Amendment
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 5210/03

84 kb
80 kb
Agreement for Services (Expert/Legal Support Services (LSS) Provider) Amendment
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 5210/03A

  93 kb
  86 kb
Agreement for Services (Expert/Legal Support Services (LSS) Provider) Rate Schedule
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 5210/04
 
  88 kb
  80 kb
Agreement for Services (Expert/Legal Support Services (LSS) Provider) Rate Schedule (Continuation Sheet)
    Adobe® PDF file
    Microsoft® Word file
 
 FDIC 5210/04A

  80 kb
  88 kb
Expert Budget
    Adobe® PDF file
    Microsoft® Word file  
 
FDIC 5210/08  
91 kb
54 kb
Expert Invoice for Fees and Expenses (EIF&E)
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 5210/01
  84 kb
  65 kb
Law Firm Travel Voucher
    Adobe® PDF file
    Microsoft® Word file
 
 FDIC 5210/12  
235 kb
115 kb
Law Firm Travel Voucher (Continuation Sheet)
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 5210/12A
174 kb
147 kb
Legal Invoice for Fees and Expenses
    Adobe® PDF file
    Microsoft® Word file  
 
FDIC 5210/11
139 kb
  61 kb
Legal Services Agreement
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 5210/13 
126 kb
  54 kb
Legal Services Agreement (LSA) Amendment
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 5210/06
  88 kb
  86 kb
Legal Services Agreement (LSA) Amendment (Continuation Sheet)
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 5210/06A
115 kb
140 kb
Legal Support Services (LSS) Provider Budget Form
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 5210/15  
219 kb
  74 kb
Legal Support Services (LSS) Provider Invoice for Fees and Expenses (IF&E)
    Adobe® PDF file
    Microsoft® Word file  
 
FDIC 5210/02
  78 kb
  82 kb
Litigation Budget
    Adobe® PDF file
    Microsoft® Word file
 
 FDIC 5000/35
124 kb
  64 kb
Non-Litigation Budget
    Adobe® PDF file
    Microsoft® Word file
 
    -
Amended Litigation Budget
Form
    Adobe® PDF file
    Microsoft® Word file  
 
 FDIC 5000/26


 
FDIC 5000/31

157 kb

119 kb


108 kb
  67 kb
Amended Non-Litigation Budget
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 5000/33 
110 kb
  71 kb
Oral Representations and Certifications for Expert Legal Support Services Telephone Authorization for Expenditures Under $5,000
    Adobe® PDF file
    Microsoft® Word file  
 
FDIC 5210/14  

205 kb
  51 kb
Outside Counsel Legal Services Agreement (LSA) Rate Schedule
    Adobe® PDF file
    Microsoft® Word file
FDIC 5210/10 
  97 kb
  86 kb
 
Outside Counsel Legal Services Agreement (LSA) Rate Schedule (Continuation Sheet)

    Adobe® PDF file
    Microsoft® Word file
FDIC 5210/10A 

103 kb
  96 kb
Representations and Certifications for Experts and Legal Support Services Provider
    Adobe® PDF file
    Microsoft® Word file
 FDIC 5210/09

  55 kb
  51 kb
 
Representations & Certifications for Legal Contractors
    Adobe® PDF file
    Microsoft® Word file
 
FDIC 5200/01
   94 kb
   66 kb

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Personnel Administration

Form Title Form Number File size
Applicant Background Questionnaire
    Adobe® PDF file
    Microsoft® Word file
FDIC 2100/14
  89 kb
  50 kb
Applicant Certification Statement
    Adobe® PDF file
    Microsoft® Word file
FDIC 2120/16
385 kb
  73 kb
Application for Student Educational Employment Program
    Adobe® PDF file
    Microsoft® Word file
FDIC 2100/08B   
128 kb
120 kb

Medical History Questionnaire

    Adobe® PDF file
    Microsoft® Word file

FDIC 2820/06

 

52 kb

72kb

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  Last Updated: 04/23/2009 Records@FDIC.GOV

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