Fillable Form 7300 CONTACT INFORMATION FORM

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Form 7300 CONTACT INFORMATION FORM

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The Form 7300 CONTACT INFORMATION FORM form is 3 pages long and contains:

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OMB Number 3064-0192
Expiration Date: 12/31/2019
PRIVACY ACT STATEMENT
The Federal Deposit Insurance Act (12 U.S.C. §§1819, 1821, and 1823) and authorizes the collection of this
information. The FDIC will use this information in the marketing of assets, to identify qualified potential
purchasers and to solicit bids for assets. Submitting this information to the FDIC is voluntary. Failure to
submit all of the information requested could result in your inability to bid on or purchase assets held by the FDIC.
The information provided by individuals is protected by the Privacy Act, 5 USC §552a. The information may be
furnished to third parties as authorized by law and in accordance with any of the other routine uses described in the
FDIC Potential Bidders List (FDIC-30-64-0019) System of Records. A complete copy of this System of Records is
available at http://www.fdic.gov/regulations/laws/rules/2000-4000.html#fdic200030--64--0019. If you have
questions or concerns about the collection or use of the information, you may contact the FDIC’s Chief Privacy
Officer at Privacy@fdic.gov.
ESTIMATED REPORTING BURDEN
Public reporting burden for this collection is estimated to average 10 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
this collection of information, including suggestions for reducing this burden, to Paperwork Reduction Act, Legal
Division, FDIC, W ashington, D.C. 20429; and to the Office of Management and Budget, Paperwork Reduction
Project (3064-0135), Washington, D.C. 20503. Respondents need not respond to this request for information
unless it displays a currently valid OMB Control Number. An agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information unless it displays a currently valid OMB control number.
FDIC 7300/08 (8-13) Page 1
OMB Number 3064-0192
Expiration Date: 12/31/2019
Federal Deposit Insurance Corporation
CONTACT INFORMATION FORM
INSTRUCTIONS: Print clearly or type. The information requested by this form is required to determine the type
of Assets a Prospective Bidder is interested in and to facilitate communication with the Prospective Bidder. The
information required by this form may be submitted in a separate typed or printed document, including by electronic
mail.
1. Name of Prospective Bidder (The name of the firm/individual)
2. Preferred Mailing Address
3. Physical Address (if different)
4. Corporate Parent or Guarantor Name
4a. Phone Number
4b. Fax Number
4c. Street Address
4d. City, State ZIP Code
4e. Email Address
5. General Partner (s) Name (If Prospective Bidder is a partnership) or Manager (If Prospective Bidder is a limited liability
company).
5a. Phone Number
5b. Fax Number
5c. Street Address
5d. City, State ZIP Code
5e. Email Address
6. Contacts (Please provide a primary and secondary contact, no more than two). (The individual to be contacted when updating
the Purchaser Eligibility Certification, to represent the firm, to receive sale notifications, to discuss other questions regarding
qualifications, their title, address, if different from above, and phone, and e-mail address).
6a. Primary Contact Name
6b. Phone Number
6c. Fax Number
6d. Street Address
6e. City, State ZIP Code
6f. Email Address
6g. Secondary Contact Name
6h. Phone Number
6i. Fax Number
6j. Street Address
6k. City, State ZIP Code
6l. Email Address
7. Product Types Offered (Check the applicable box(es) for the type of product that you (or your organization) are interested in
bidding on.) The assets available for sale may vary significantly at any given time and are dependent on the assets held by the
FDIC as Receiver for financial institutions.
Agency Securities Private-Label MBS/Other Asset- CMO’s/CDO’s
Backed Securities
Corporate Bonds/Notes High-Yield Bonds Interest-Only (IO)/Principal Only (PO)
Limited Partnership Municipal Securities Common Stock/Preferred Stock
U.S. Treasuries Other Sovereign Debt Syndicated Loans
Structured Transactions* Trust Preferred Securities (TruPS) Other Financial Assets**
*Structured Transactions. The sale of equity interests in newly formed special-purpose limited liability companies to which the
FDIC as Receiver for one or more failed financial institutions has transferred primarily nonperforming residential, commercial or
construction real estate mortgage loans and related assets.
Other Financial Assets. CRA-Related Assets, Credit Card Receivables, Interest Rate Swaps, Other Derivative Products, Loan
Production Platforms, Residuals, Servicing Rights, etc. Indicate below:
FDIC 7300/08 (8-13) Page 2
8. The FDIC welcomes and strongly encourages participation of minority- or women-owned businesses (“MWO Businesses”) in
FDIC structured transactions and other asset disposition transactions. Entities that qualify as MWO Businesses
1
will have the
opportunity to disclose such information during the pre-qualification and qualification process so that the FDIC can examine the
level of MWO Business interest in future structured transactions and other asset disposition opportunities and identify additional
MWO Business outreach activities to support diversity of participation. Therefore, the FDIC would appreciate MWO Business
assistance in completing the survey below relating to MWO Business status and checking all appropriate responses. Please
understand that disclosure of information concerning MWO Business status is for FDIC informational purposes only.
Are you a minority, or is your entity, minority-owned?
Yes No
Race/Ethnicity
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Island
Hispanic or Latino
Are you a woman, or is your entity, women-owned?
Yes No
The foregoing information was submitted by ____________________ (Type or Print name of individual completing this
Form) as of, ____________ , 20 (date on which form is provided).
1
MW O Businesses are at least 51% owned and controlled, through day-to-day management by persons of one or more of the
following groups: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific
Islander, Hispanic or Latino and/or Women.
1
MWO Businesses are at least 51% owned and controlled, through day-to-day
management by persons of one or more of the following groups: American Indian or Alaska Native, Asian, Black or African
American, Native Hawaiian or Other Pacific Islander, Hispanic or Latino and/or Women.
FDIC 7300/08 (8-13) Page 3
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Form 7300 CONTACT INFORMATION FORM

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Completed 24 February 2020

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