Chartering and Field of Membership Manual
The NCUA Chartering and Field of Membership Forms
Users can print out or save the NCUA Chartering and Field of Membership Forms that are listed below. All forms are in PDF. More guidance on using and submitting these forms can be found in the Chartering Manual.
Chartering Forms
NCUA 4001 - Federal Credit Union Investigation Report.
NCUA 4008 - Organization Certificate.
NCUA 4009 - Approval of Organization Certificate and Certification of Insurance.
NCUA 4012 - Report of Official and Agreement to Serve.
NCUA 9500 - Application and Agreements for Insurance of Accounts.
NCUA 9501 - Certification of Resolutions.
NCUA 9600 - Information to be Provided in Support of the Application of a State Chartered Credit Union for Insurance of Accounts.
Field of Membership Forms
NCUA 4015 - Application for Field of Membership Amendment.
NCUA 4015-A - Application for Field of Membership Amendment (use for multiple common bond expansion for groups of 3,000 to 4,999 persons).
NCUA 4015-EZ - Application for Field of Membership Amendment (use for all single common bond expansions and multiple common bond expansions of less than 3,000).
Charter Conversion Forms
NCUA 4000 - Conversion of State Charter to a Federal Charter – Federal Credit Union Investigation Report.
NCUA 4221 - Notice of Meeting of Members to Convert from a Federal to State Chartered Credit Union.
NCUA 4401 - Application to Convert from a State to a Federal Credit Union.
NCUA 4505 - Affidavit - Proof of Results of Membership Vote - Proposed Conversion From Federal Credit Union to State Credit Union.
NCUA 4506 - Federal to State Conversion - Ballot for Conversion Proposal.