(To be filed in duplicate)

The    (Applicant alien bank)   , with its head office and principal place of business located at    (Domiciliary Country)   , hereby initiates this application for certificate authorizing the establishment and operation of a bureau to be located . . . . . . . . in the City of . . . . . . , County of . . . . . . . . , State of Washington.

The    (Bank)    is incorporated, chartered or otherwise authorized to conduct a banking business under the laws of    (Domiciliary Country)   .

We enclose a verified copy of the resolution, adopted . . . . . . by the bank's governing board, specifically empowering its President (or Chief Executive Officer) and the bank's Secretary (or equivalent officer) to execute this application, pay the fees required by law or regulation, provide such information and furnish such reports and enter into such agreements as may be necessary.

Correspondence, instructions, and requests for information, reports, etc., should be addressed:

To expedite the statutory investigation, the following information, schedules, documents, etc., are furnished:

(a) Name of present Chief Executive Officer . . . . . . . . and name of the Secretary . . . . . . . .

(b) The bank's fiscal year ends . . . .

(c) (English translation) Four certified copies of most recent edition of the bank's certificate of authority or other legal authorization of your country to conduct an international banking business and the bank's articles of incorporation.

(d) Date of certificate of authority or its equivalent under which presently operating . . . . . . . . and expiration date, or duration, of the certificate of authority or its equivalent . . . .

(e) Capital structure at end of last fiscal year: (i.e., equity capital, surplus or rest accounts, undivided profits, unallocated or contingency reserves).

(f) Two copies of last available statement of condition.

(g) Statement of object, purpose and activities which bank proposes to pursue the establishment and operation of a bureau in this state at the place designated herein.

Enclosed is a bank draft for $300.00 to apply upon the statutory cost of investigation. If the cost of investigation to be made exceeds $300.00, we agree to pay such excess in accordance with WAC 208-512-040 together with such other costs and fees as may be legally required by state or regulation.

. . . .executed in duplicate at . . . . . . . . . . .

for the (Legal name of applicant bank)  this . . . . . day of . . . . . . , 19 . . .

Bank Seal

*Please type name and official title under the signatures.