Fillable FEDERAL HOME LOAN BANK INDEPENDENT DIRECTOR APPLICATION FORM (Federal Housing Finance Agency)

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FEDERAL HOME LOAN BANK INDEPENDENT DIRECTOR APPLICATION FORM (Federal Housing Finance Agency)

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Page 1 of 8 Expires 2/28/2021
OMB No. 2590-0006
FEDERAL HOME LOAN BANK
INDEPENDENT DIRECTOR
APPLICATION FORM
PERSONAL INFORMATION
Full name: _____________________________________________________________
Address:
Current employment:
_______________________________________ ________________________________
Name of organization Your title or position
____________________ ____________________ __________________________
Telephone number Fax number E-mail address
_____________________________ __________________ _______ _________
Street City State Zip code
_____________________________ _________________ ________ _________
Mailing address (if different) City State Zip code
Page 2 of 8 Expires 2/28/2021
OMB No. 2590-0006
STATUTORY ELIGIBLITY REQUIREMENTS
An individual must satisfy certain statutory requirements in order to be eligible for election as an
independent director of a Federal Home Loan Bank (Bank). The requirements relate to
citizenship, residency, and, for prospective public interest directors, experience in that field. The
statute also prohibits an independent director from serving as an officer, employee, or director of
an institution that is a member of, or that receives advances from, the Bank on whose board the
director serves. The questions below address these statutory requirements.
1. Citizenship. Are you a citizen of the United States? Yes No
2. Residency. In order to be an independent director you must be a bona fide resident of a state
that is in the geographic district of the Bank on whose board you wish to serve. You will satisfy
this requirement if your principal residence is located in that geographic district (A), or if you
own or lease a second residence in the district and are employed in the district (B). Please
indicate the basis you are using to demonstrate bona fide residence.
A. Is your principal residence located in the Bank’s geographic district? Yes No
B. If you answered No, do you own or lease a second residence in the Bank’s district and are
you employed in the district? Yes No
If so, provide the address of your second home, the name of, and identifying information on,
your employer, and your title or position, if different from that on page 1 of this Form.
Second home address:
Employer information:
______________________________________ __________________________________
Name of organization Your title or position
_____________________ _________________ __________________________
Telephone number Fax number E-mail address
_____________________________ ________________ ______________ ________
Street City State Zip code
_____________________________ _____________ ____________ ________
Mailing address (if different) City State Zip code
Page 3 of 8 Expires 2/28/2021
OMB No. 2590-0006
3. Public Interest Directors. If you are seeking election as a public interest director, you must
be able to demonstrate that you have more than four years experience representing consumer or
community interests on banking services, credit needs, housing, or consumer financial
protections.
If you meet this requirement, provide information on how you have represented such consumer
or community interests for more than four years.
4. Conflicts of interest. Independent directors and their spouses may not serve as an officer of
any Bank or as an officer, employee, or director of any member of, or any recipient of advances
from, the Bank on whose board the independent director serves. You and your spouse will have
to give up any conflicting position before you can become a Bank director.
For purposes of this conflict of interest provision, the terms:
“Member” and “Recipient of advances” include the institution itself and any subsidiary of the
institution. If the institution is owned by a holding company, the terms include the holding
company if 35 percent or more of the holding company’s assets, on a consolidated basis, are
attributable to institutions that are members of, or recipients of advances from, the Bank on
whose board the independent director serves. Thus, you may not serve as a director, employee,
or officer of a holding company if one or more members of, or one or more recipients of
advances from, your Bank constitute 35 percent or more of the holding company’s assets.
A. Please specify each position you and your spouse have in any member of, or recipient of
advances from, the Bank on whose board you would serve.
B. Do you agree to give up positions that are deemed to be conflicting interests before
becoming an independent director of that Bank? Yes No
Page 4 of 8 Expires 2/28/2021
OMB No. 2590-0006
SELECTION CRITERIA
The Banks are multi-billion dollar financial institutions, the principal business of which is to
borrow funds in the capital markets and then provide secured loans to their members. Each Bank
is required to have independent directors who possess knowledge or expertise in financial
management, derivatives, auditing and accounting, risk management practices, project
development, organizational management, or the law.
1. Leadership Experience. Bank directors should have experience in senior management or
policy-making in one or more fields of business, government, education, or community/civic
affairs, and should have a record of achievement in their chosen profession or field of business.
This experience should provide directors with the ability to understand the business of the Bank,
to act independently, and to ask Bank management appropriate questions about how they are
conducting Bank business.
A. If you have ever served as the CEO, CFO, COO, or in a similar capacity for a business
enterprise, or as a dean or senior faculty member at a prominent college or university, or as a
senior official for a federal or state government or prominent nonprofit organization, please
provide the details for those positions, including the dates of service and the positions held.
B. If you have other experience dealing with issues such as developing or implementing
business strategies, overseeing regulatory compliance, corporate governance, or board
operations, or have previously served on the board of a large business enterprise, please
describe those experiences.
C. If you have other significant business or professional achievements that demonstrate your
ability to lead an organization please describe them.
Page 5 of 8 Expires 2/28/2021
OMB No. 2590-0006
2. Business Knowledge. Bank directors must be financially literate, meaning they must be
familiar with how financial statements and various financial ratios are used in managing a
business enterprise, how basic accounting conventions apply to the Bank, and how internal
controls are used to manage risk. They also must have some knowledge about one or more of the
areas of the Bank’s business, such as mortgage finance, capital markets transactions,
accounting/modeling practices, affordable housing, community and economic development, and
legal and regulatory compliance.
A. Do you know how to read and understand a financial statement, and do you understand
how financial ratios and other indices are used for evaluating the performance of a business
enterprise? Yes No
If you answered Yes, please describe the setting in which you gained that knowledge.
B. Do you have a working familiarity with basic finance and accounting practices, including
internal controls and risk management? Yes No
If you answered Yes, please describe the setting in which you acquired that knowledge.
C. Do you have experience with financial accounting and auditing, particularly with a
publicly traded company? Yes No
If you answered Yes, please describe that experience.
Page 6 of 8 Expires 2/28/2021
OMB No. 2590-0006
D. Do you have experience in project development or organizational management?
Yes No
If you answered Yes, please describe that experience.
E. Do you have experience in an organization providing financing for residential mortgages,
housing for low or moderate income individuals and families, or real estate development?
Yes No
If you answered Yes, please describe that experience.
F. Have you served in any position that required an understanding of the legal and other
fiduciary obligations associated with being an independent director? Yes No
If you answered Yes, please describe that experience.
G. The mission of the Banks is to support the housing finance activities of their members,
which includes residential mortgage finance and community and economic development
lending activities. Please describe any prior experience that is related to the mission of the
Banks.
Page 7 of 8 Expires 2/28/2021
OMB No. 2590-0006
3. Commitment to Service. In order to serve effectively on the board of a Bank, a director must
be able to attend the meetings of the board of directors and subcommittees on which the director
serves, and to devote the time necessary to prepare for those meetings.
A. Do you have any other business or professional commitments that would hinder your
ability to prepare for and attend board of director and committee meetings? Yes No
If so, please describe the constraints on your ability to serve.
B. If you serve on any other corporate boards, please provide the name and location of the
organization, your role (e.g., chair and committee assignments), and the term of service.
___________________________ _______________________ ________________
Name of organization Your role Term
___________________________ _______________________ ________________
Name of organization Your role Term
___________________________ _______________________ ________________
Name of organization Your role Term
4. Personal Integrity. Character is an important consideration in evaluating any prospective
Bank director. All directors must have high ethical standards and integrity in both their personal
and professional dealings. Please indicate whether you ever have been convicted of a felony,
been found to have violated any federal or state civil laws relating to the securities, banking,
housing or real estate industries, or have had a professional license suspended or revoked.
Yes No
If you answered Yes, please explain.
Page 8 of 8 Expires 2/28/2021
OMB No. 2590-0006
5. Independence. It is essential that an independent director be able to act independently of
management in overseeing the policy and operations of a Bank, and not have any relationships
that may create actual or apparent conflicts of interest. Please disclose whether you have any
familial or business relationships with any members of Bank management or the board of
directors of the Bank, and any other relationship(s) that might lead a reasonable person to
question your independence. Yes No
If you answered Yes, please explain.
6. Other Experience and Education. Please provide a copy of your resume if it describes other
business, professional, or educational achievements that are not described in the responses to the
questions above. Resume attached. Yes No
BY EXECUTING AND SUBMITTING THIS APPLICATION FORM, YOU ARE
CERTIFYING THAT THE INFORMATION YOU PROVIDED IS TRUE, CORRECT,
AND COMPLETE TO THE BEST OF YOUR KNOWLEDGE AND THAT YOU AGREE
TO SERVE AS A DIRECTOR IF ELECTED.
________________________________________ _______________________
Signature Date
Privacy Act Statement: In accordance with the Privacy Act (5 U.S.C. 552a), the following notice is provided. This information is solicited
u
nder authority of 12 U.S.C. 1427(a) and (b); and 12 CFR 1261.5, 1261.7, and 1261.10 to 1261.13. Furnishing the information on this form
is voluntary, but failure to do so may result in you not meeting the statutory and regulatory eligibility requirements to serve as an independent
director. The purpose of this information is to facilitate the timely determination of your eligibility to serve as an independent director.
Information may be disclosed in accordance with the routine uses identified in FHFA-System of Records Notice FHFA-8 Federal Home
Loan Bank Directors, which may be found at https://www.fhfa.gov/SupervisionRegulation/Rules/Pages/Privacy-Act-of-1974-System-of-
Records-Notice-of-the-Establishment-of-New-Systems-of-Records.aspx.
Paperwork Reduction Act Statement: Notwithstanding any other provision of the law, no person is required to respond to, nor shall any
person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction
Act, unless that collection of information displays a currently valid OMB Control Number.
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FEDERAL HOME LOAN BANK INDEPENDENT DIRECTOR APPLICATION FORM (Federal Housing Finance Agency)

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Completed 10 August 2020

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