In order for the FDIC to process the insurance payment on your deposits
at the closed institution, the following forms may be required. Failure
to submit the required information and forms will delay the payment of
your deposit. Copies of these forms are attached and can also be retrieved
from the FDIC website: www.fdic.gov. Part I identifies the various
affidavits and declarations that may be needed. Part II outlines the types
of deposits and ownership capacities and the documentation required.
The above form is required for all testamentary deposits that are also known as payable on death (POD) accounts, revocable trusts and in trust for (ITF) accounts. Submit for all deposits $250,000 or greater in the aggregate.
Required of corporations, partnerships or unincorporated associations when the depositor states that the funds in two or more accounts are owned by separate entities. If this form is needed, the FDIC will make a request through the first-tier broker.
For all IRA and KEOGH deposit accounts $250,000 or greater in the aggregate,
the FDIC requires that the standard IRA agreement between the broker and the
IRA owner be submitted. If there is not one, complete and submit this form.
Corporation, Partnership, or Unincorporated Association Deposit
affidavit or declaration is required. One of the Declaration of Independent
Activity forms may be needed under certain circumstances. The FDIC will notify
the first-tier broker if one of the following forms is needed: