STATE OF ILLINOIS - Department of Financial & Professional ...



STATE OF ILLINOIS

DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION

DIVISION OF BANKING

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NOTICE OF INTENT TO PROVIDE A PRODUCT OR SERVICE

PURSUANT TO THE SUPER WILDCARD

Under the provisions of the Illinois Freedom of Information Act (5 ILCS 140/1 et seq.), this Notice is considered a public document and may be available to the public upon request.

INSTRUCTIONS:

1. Applications should be submitted in an electronic version (CD or Diskette) or by e-mail. A paper version may be submitted as an alternative, but an electronic version in either a Word or Excel format is preferred. The application and non-refundable filing fee, made payable to the “Department of Financial and Professional Regulation”, must be submitted to the Springfield office. Applications may also be submitted electronically to: IDFPR.BanksandTrustApps@

Department of Financial and Professional Regulation

Division of Banking

Corporate Activities Section

320 West Washington Street

Springfield, IL 62786

If you are submitting your application by e-mail, please send a copy of the application transmittal letter along with payment to ensure it is credited to the correct application.

2. Additional pages may be attached to this Notice as inserts wherever the space provided in the Notice is insufficient. Label additional pages with the preceding page number followed by a letter (i.e. 7a, 7b...).

3. Attach a copy of the Bank’s business plan regarding the conduct of the proposed activity.

4. Questions pertaining to this application should be directed to the Corporate Activities Section at (217) 785-2900.

Banks are reminded that if they intend to provide the proposed product or service through a subsidiary, the Bank must file a Notice of Intent to Establish a Subsidiary or Acquire Stock in a Corporation pursuant to Section 5(12) of the Illinois Banking Act (“Act”).

Instructions continued

This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose outlined under Section 5(25) of the Act [205 ILCS 5/5(25)]. Disclosure of this information is REQUIRED. Failure to provide any information will result in this form not being processed. This form has been approved by the Department of Financial and Professional Regulation's Form Coordinator.

INFORMATION:

1. Name and Address of Bank:

     

2. Briefly describe the proposed activity and the manner in which it will be conducted.

     

3. Describe the Bank’s proposed direct or indirect investment in the activity. In addition, provide calculations sufficient to indicate compliance with any investment limitations prescribed by law or regulation.

     

4. Indicate the citation to the statutory or regulatory authority for the conduct of the activity.

     

5. Describe the Bank’s policy and practice with regard to any anticipated involvement in the activity by a director, executive officer, or principal shareholder of the Bank or any related interest, as that term is defined in 12 C.F.R. 215.2, of such a person.

     

6. Describe the Bank’s expertise in the activity. Identify the Bank employee responsible for managing the new activity and briefly describe that employee’s expertise in the activity.

     

The undersigned attests that he/she is authorized to sign this Notice and the statements therein are true and correct to the best of his/her knowledge and belief.

           

Name Title

           

Signature Date

Please list the name, address, and telephone number of the individual who may be contacted to provide additional information with respect to this Notice.

     

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