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Federal Deposit
Insurance Corporation

Each depositor insured to at least $250,000 per insured bank

Forms

Deposit Claims & Asset Sales

Information on downloading and using these files is at:  Word Help. Unless otherwise noted, all forms are less than 250k

Form Title/Number  
Declaration for Government Deposit
FDIC 7200/04, OMB 3064-0143 (08/31/2020)
Word file
Declaration for Trust
FDIC 7200/05, OMB 3064-0143 (08/31/2020)
Word file
Declaration of Independent Activity
FDIC 7200/06, OMB 3064-0143 (08/31/2020)
Word file
Declaration of Independent Activity for Unincorporated Association
FDIC 7200/07, OMB 3064-0143 (08/31/2020)
Word file
Declaration for Joint Ownership Deposit
FDIC 7200/08, OMB 3064-0143 (08/31/2020)
Word file
Declaration for Testamentary Deposit
FDIC 7200/09, OMB 3064-0143 (08/31/2020)
Word file
Declaration for Defined Contribution Plan
FDIC 7200/10, OMB 3064-0143 (08/31/2020)
Word file
Declaration for IRA/KEOGH Deposit
FDIC 7200/11, OMB 3064-0143 (08/31/2020)
Word file
Declaration for Defined Benefit Plan
FDIC 7200/12, OMB 3064-0143 (08/31/2020)
Word file
Declaration for Custodian Deposit
FDIC 7200/13, OMB 3064-0143 (08/31/2020)
Word file
Declaration for Health and Welfare Plan
FDIC 7200/14, OMB 3064-0143 (08/31/2020)
Word file
Declaration for Plan and Trust
FDIC 7200/15, OMB 3064-0143 (08/31/2020)
Word file
Declaration for Power of Attorney
FDIC 7200/16
Word file
Declaration for Irrevocable Trust
FDIC 7200/18, OMB 3064-0143 (08/31/2020)
Word file
Depositor Interview Form
FDIC 7200/26, OMB 3064-0143 (08/31/2020)
Word file
Purchaser Eligibility Certification
FDIC 7300/06, OMB 3064-0135 (10/31/2018)


The Purchaser Eligibility Certification for a specific sale will be available on the website of the loan sale advisor responsible for that sale. Purchasers will complete that form and provide it to the loan sale advisor. In order to self screen, Potential Purchasers can review this sample copy of the Purchaser Eligibility Certification.

 
Word file



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