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Complete Remaining Required NCUA Forms

Complete Remaining Required NCUA Forms

Appendix B to Part 701 - Chartering and Field of Membership Manual, contains the required chartering forms. These forms must be completed and signed by the appropriate individuals before a final approval may be issued.

The forms are:

NCUA 4008 – Organization Certificate, signed by each subscriber (minimum seven subscribers required). Ensure each subscriber’s signature matches the printed version of the subscriber’s name on this form, and that the names on this form are identical to the names of subscribers listed on the NCUA 4001 form. Provide two notarized copies of this form to the NCUA.

NOTE: NCUA recommends submitting the two notarized copies of the NCUA 4008 form after NCUA approves all subscribers, to prevent filing of a revised NCUA 4008 form if any subscribers are not approved to serve after NCUA conducts the credit and criminal background checks. Similar changes may be needed to other forms (for example, NCUA 4001) due to NCUA’s credit and criminal background investigations.

NCUA 4012 – Report of Official and Agreement to Serve, signed by each individual who will serve as a credit union board member, supervisory committee member, credit committee member (if one is formed), and each staff member serving in a senior management capacity. Senior management is defined as a credit union’s chief executive officer (typically this individual holds the title of president or treasurer/manager), any assistant chief executive officer (any assistant president, any vice president, or any assistant treasurer/manager), and the chief financial officer (controller). The term “senior executive officer” also includes employees of an entity, such as a consulting firm, hired to perform the functions of positions covered by the regulation.

The NCUA will evaluate a prospective applicant’s competence, experience, character, and integrity to ensure their association with a newly chartered credit union is in the best interests of the credit union's members and the public. This evaluation is performed through a review of every individual’s NCUA 4012 form, resume, credit report, and criminal background check. All resumes were submitted in Phase 2 with the business plan. Submit the NCUA 4012 forms during this Phase 3.

If the evaluation identifies adverse information, the applicant will be asked to explain in writing the circumstances which led to the adverse information, action taken to resolve the concerns, and steps taken to avoid similar concerns in the future. Other documentation may be requested to support the written explanation, such as proof of payment and/or agreements reached with creditors. The NCUA will notify each applicant and the organizer of an individual’s approval or denial to serve as an official or employee for the PFCU.

NCUA 9500 – Application and Agreement for Insurance of Accounts, signed by the individuals appointed Chairperson and Chief Financial Officer (or Treasurer).

NCUA 9501 – Certificate of Resolution, signed by the individual assigned Chief Executive Officer and appointed Recording Officer for the Board of Directors (or Secretary).

Documentation for Required Forms

  • Submit forms NCUA 4008, 9500, and 9501.
  • Submit individual NCUA 4012 forms for all officials and senior management. Ensure each NCUA 4012 form is appropriately completed, including the Authorization to Perform a Credit Check, and that the applicant’s signature is witnessed.


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