New Jersey Department of Banking and Insurance
Branch Office Application Out-Of-State Bank
Exact Corporate Title _______________________________________________

Exact Street Address of Head Office, City, County, State, Zip Code

Charter No/FDIC Cert. No. ____________________________________
Filing Officer Name __________________________________________
Filing Officer Title ___________________________________________
Filing Offer’s E-mail address___________________________________
Filing Officer Phone Number ( _________ ) ______________________
Filing Officer's Address _____________________________________________________________

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

Filing Fee: $1,500.00

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. Please submit an original and one copy of this application.

1. Location of proposed branch:


2. Name of depository selling the branch:


3. If the out-of-state bank intends to immediately relocate the branch to a new location in this State, the exact location of the proposed relocation:


4. Attached hereto a certified copy of the resolution of the board of directors authorizing the application.


5. Describe in detail how the approval of the application will benefit the public:


6. 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.


7. Attach hereto an opinion of counsel that the out-of-State bank is authorized to acquire a branch in New Jersey and a copy of the application (if applicable) with the out-of-State bank's home state regulator.