New Jersey Department of Banking and Insurance

Mini-Branch Office Application


Depository Institution: _______________________________________________
Filing Officer: _____________________________________________
Filing Officer’s E-mail address __________________________
Filing Officer’s Title: ___________________________________________
Mailing Address: ______________________________________________________
Telephone Number: (______) __________________________

NOTE: Board Resolution MUST Be Enclosed

Application Date: (mm-dd-yyyy) |__|__|-|__|__|-|__|__|__|__|

Projected Operational Date: (mm-dd-yyyy) |__|__|-|__|__|-|__|__|__|__|

Answer questions in the spaces provided or by attaching additional pages as necessary. Questions can
also be answered in "letter form." The applicant may supply additional data deemed relevant.


  1. Location of proposed mini branch: _______________________________________________

  2. Attach hereto a certified copy of the resolution of the board of directors authorizing the application.

  3. Give a breakdown of aggregate figures (Net of Depreciation) representing fixed assets as reflected
    in the most recent report of condition (Call report filed with FFIEC)

(a) Bank Premises


(b) Furniture and Fixtures


(c) Leasehold





Other assets representing bank premises


  1. Describe in detail how the approval of the application will benefit the convenience and needs
    of the public.


  1. Add general comments which the applicant wishes the Department to consider. Comments should
    include a brief discussion of the bank's capital ratio; earnings; nonperforming assets and compliance
    with the Community Reinvestment Act.


  1. The Mini Branch site is to be (owned - leased - capitalized lease). (circle one)

(a) Cost of the land and building


(b) Cost of Furniture and fixtures:




(c) Cost of staffing office*
* Estimated first year salary of employees of mini branch


(d) Total cost




(e) Size of lot or tract of site:


(f) Mini Branch office floor area (square feet)**


** If in excess of 500 sq. ft., explain how excess will not violate N.J.A.C. 3:1-2.12

  1. Do the contemplated expenditures plus the present book value of your bank premises investment
  2. fall within the statutory limitations (see N.J.S.A. 17:9A-24(13) or N.J.S.A. 17:12B-166)?
    Yes checkbox No checkbox (check one)

If no, explain how over investment would be cured.

  1. Do the applicant's executive officers or directors have a direct or indirect interest in the premises
    which will be purchased or leased? If yes, see N.J.A.C. 3:1-10.1 et seq. If applicable attach
    Form 114 and an independent appraisal of lease or purchase.


  1. If the proposed transaction involves the acquisition of deposits from another banking institution:

    1. Pro forma balance sheet projections reflecting the acquiring depository before and after
      the acquisition; and

    2. Projections of the ratio of Tier 1 capital to total assets of the depository before and after
      the acquisition.