OMB No.: 1557-0124
Expiration Date: April 30, 2021
NOTICE OF WITHDRAWAL FROM REGISTRATION AS A TRANSFER AGENT
DISCLOSURE OF ESTIMATED REPORTING BURDEN
Public reporting for this collection of information is estimated to average .5 hours per deregistration including searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden, to the Legislative and Regulatory Activities Division, Office of the Comptroller of the Currency, Washington, DC 20219;
and to the Office of Management and Budget, ATTN: Paperwork Reduction Project, Washington, DC 20503.
Location (City and State)
Registered Transfer Agent Number
nish registrant’s reasons for ceasing the performance of transfer agent functions or for otherwise
requesting withdrawal of its registration.
2. Furnish the date on which the bank last transferred any securities for which registration would be
nish the name(s) and location(s) of the organization or person, which will retain possession of the
books and records which the bank maintained for its registered transfer agent functions.
nish the name(s) and location(s) of any successor transfer agent(s).
5. Describe any legal actions or proceedings, or potential claims against the bank, in connection with the
performance of its registered transfer agent functions.
cribe any unsatisfied judgements or liens against the bank arising out of performance of its
registered transfer agent functions.
Execution: I certify that the information contained herein is true and correct to the best of my
knowledge and belief.
NAME AND TITLE OF OFFICIAL RESPONSIBLE FOR REQUEST
SIGNATURE OF OFFICIAL RESPONSIBLE FOR REQUEST
Return completed form (original only) to:
Comptroller of the Currency
Asset Management Group, MS 7W-3
A copy should also be kept for the bank’s files.