Summary of Deposits Form (Redlined )

OMB Number: 3064-0061
Expires: 10/31/2026

SUMMARY OF DEPOSITS
As of Close of Business: _______________________________

State

Institution

Cert

Uninum

Instructions: Please read the attached instructions before you fill out this form. Report amounts of deposits in thousands. Total deposits for all offices must equal total deposits on the Report of
Condition (for the "As of Close of Business" date listed above) sent to your main regulatory agency. Make a copy for your files.
SUMMARY OF DEPOSITS

REPORT OF CONDITION
(FFIEC 031/041/051 form)

US BRANCHES OF FOREIGN BANKS
(FFIEC 002 form)

TOTAL DEPOSITS =

SCHEDULE RC ITEM 13.A +
DEPOSITS IN OTHER AREAS

SCHEDULE E ITEM 7 A & C

Office Number

Change
Code

Effective Date
CCYY/MM/DD

Service Type

Office Name & Address
County

(CONTINUED ON NEXT PAGE)

CEN
Code

MAILING ADDRESS

Consolidated
Office

Total Deposits

OMB Number: 3064-0061
Expires: 10/31/2026

SUMMARY OF DEPOSITS
As of Close of Business ____________________

Office Number

Change
Code

Effective Date
CCYY/MM/DD

Service Type

State

Institution

Cert

Uninum

Office Name & Address
County

(CONTINUED ON NEXT PAGE)

CEN
Code

Consolidated
Office

Total Deposits

OMB Number: 3064-0061
Expires: 10/31/2026

SUMMARY OF DEPOSITS
As of Close of Business ________________

Office
Number

Change
Code

Effective Date
CCYY/MM/DD

Service Type

State

Institution

Cert

Uninum

Office Name & Address
County

CEN
Code

Consolidated
Office

Total Deposits

TOTAL DEPOSITS FOR ALL OFFICES
I have verified this statement according to the instructions provided, and attest that it is correct and complete to the best of my knowledge and belief and that the deposit totals agree with those reported
on the stated Report of Condition.

Preparer / Contact Name and Telephone Number (Please Print)

Authorized Official Signature

Date