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217
BOARD OF G O V E R N O R S
OF THE
FEDERAL RESERVE SYSTEM
islBlii
WASHINGTON
R-932
A D D R E S S OFFICIAL C O R R E S P O N D E N C E
TO THE BOARD
December 13, 1941
Dear Sir:
Enclosed are 25 copies of a specimen
OF BORROWER which the Board has prescribed for
1, 194-2, pursuant to the provisions of section
This specimen form has been designated as Form
form of the STATEMENT
use on and after January
5(d) of Regulation W.
F.R. 5'oL.
The forms for actual use by Registrants will not be printed
t y the Board or t y the Reserve Banks, but specimen forms are to be disr
r
tributed t y the Federal Reserve Banks to the lending trade so that
r
Registrants may secure a supply either by printing or otherwise reproducing them or by obtaining them from stationery or supply houses. The
notice at the top of the form indicates the restrictions, on reproduction .
It is suggested that your Bank should .print a supply of the
specimen form in such number as will permit a distribution of one copy
to each Registrant in your District who appears to be engaged to any
extent in the business of extending instalment loan credit. Such additional specimen copies as you deem necessary may be distributed to
Registrants and others for sample purposes. The Board requests that
the Reserve Banks, in preparing sample copies, adhere strictly to the
size of the sheet and the style of type used for the specimen copy.
You will also find herewith a suggested form of "Notice Regarding Use of Statement of Borrower in Connection with Regulation W".
This form is designed to serve only as a suggestion to the Reserve
Banks and, of course, you are at liberty to compose your own appropriate form of notice or to modify or alter the suggested form in any
particular.
Use by Registrants of this form of Statement of Borrower
will demonstrate whether the form accomplishes its obvious objective.
The Reserve Banks are invited to comment from time to time on reactions
from the trade and the public.
—2—
H-932
The Board and its staff gratefully acknowledge the helpful
suggestions of the Reserve Banks.
Very truly yours,
Chester Morrill,
Secretary.
Enclosures
TO THE PRESIDENTS OF ALL FEDERAL RESERVE BANKS
FEDERAL RESERVE BANK OF
—
219
NOTICE REGARDING THE "STATEMENT OF BORROWER"
PRESCRIBED FOR USE IN CONNECTION V.ITH REGULATION W
Regulation W, relating to consumer credit, which was issued by
the Board of Governors of the Federal Reserve System pursuant to Executive Order No. 8843 of the President of the United. States, provides that,
on and after January 1, 1942, no Registrant shall make any extension of
instalment loan credit (with certain exceptions) unless, at or before
the execution of the loan contract, he obtains and accepts in good faith
a signed Statement of the Borrower as to the purposes of the loan in form
prescribed by the Board.
A specimen copy of the form which the Board has prescribed for
use in this connection is enclosed.
The forms will not be supplied by
the Board or by this Bank but should be printed or otherwise reproduced
by the Registrant or obtained by him from stationery or supply houses.
Your attention is called to the fact that the form should be reproduced
only in accordance with the instructions at the top of the specimen form.
Your attention is also called to the fact that Registrants are instructed
to keep all such statements on file.
Any inquiry relating to this form should be addressed to the
Federal Reserve Bank of
or to its
Branches(es).
220
S P E C I M E N
FORM
Form F. R. 564.
F O R I N F O R M A T I O N O F R E G I S T R A N T OR P R I N T E R O N L Y — N O T TO B E P R I N T E D AS P A R T O F F O R M : In reproducing this form,
the Registrant or printer shall follow exactly the wording and arrangement of the front and back of the form, but may vary the spacing as desired.
Additions to the form, such as an acknowledgment by the borrower that he has received a copy, are permitted provided they do not call for the obtaining
of any additional information from the borrower.
Since the form may be changed from time to time, it is suggested that Registrants do not stock large supplies of the form.
STATEMENT OF BORROWER
Prescribed by the Board of Governors of the Federal Reserve System under its Regulation W , issued pursuant
to Executive Order No. 8843 of the President of the United States.
T O B E F I L L E D I N BY R E G I S T R A N T
(Name of Registrant)
$-
(Date of Loan)
(Amount of Loan)
(Answer
1. Is any of the money from this loan to be used to buy a Listed Article?
(See statement on back of this sheet)
"Yes" or "No")
(Answer)
2. Is any part of this loan to be secured by any Listed Article which you have
bought within the last 45 days or which you intend to buy ?
(Answer)
3. Is any of the money from this loan to be used to pay all or part of any
instalment debt?
(Answer)
4. Is any of the money from this loan to be used as a down payment on the
purchase of a Listed Article?
(Answer)
In determining whether any article involved in this loan is a Listed Article, I have been guided by information
furnished by the lender. I certify that, to the best of my knowledge, the information given by me on this sheet
is true and complete.
{Date)
(Borrower's
Signature)
5. IF EITHER QUESTION 1 OR 2 HAS BEEN ANSWERED "YES", the following information must be
obtained from borrower:
Listed Article Bought or To Be Bought
Purchase
Date Purchased
Trade-in
Amount
or Used as Security
Price
{If before loan)
Allowance
To Be Borrowed
Have you borrowed any money elsewhere, or do you intend to borrow any, to be used in buying any of the
Listed Articles specified above?
If "Yes", how much? $
{Answer "Yes" or "No")
6. IF QUESTION 3 HAS BEEN ANSWERED "YES", the following information must be obtained f r o m
borrower:
Total
Amount
Name of Person Holding Debt
Unpaid Balance
Instalment Terms
To Be Paid Off
•
$
$
$
*
NOTICE TO LENDER.—The lender, acting in good faith, may rely upon the above statements of the borrower.
However, this form does not provide all of the information that it may be necessary for the lender to have if
he intends to avail himself of certain provisions of Regulation W . In any case as to which the lender must
obtain additional information in order to be protected in making the particular loan under consideration, the
facts themselves will govern. This, however, does not affect the right of the lender to rely upon statements of
fact obtained from the borrower pursuant to applicable provisions of the Regulation.
THE REGISTRANT RECEIVING THIS STATEMENT MUST KEEP IT ON FILE
*
LISTED ARTICLES
The instalment purchase of classes of consumers' durable goods using materials, labor, and equipment needed
for national defense is regulated under the President's Executive Order No. 8843, Regulation W covers the
extension of credit to buy these articles, whether bought directly on instalment payments or with money borrowed
on an instalment basis. The following are the classes of "Listed Articles" based upon the Supplement of
Regulation W in effect December i, 194-1, but articles may be added to or taken from the list at any time. IN
D E T E R M I N I N G W H E T H E R A N A R T I C L E I N V O L V E D I N A L O A N IS A " L I S T E D A R T I C L E "
A B O R R O W E R MAY BE G U I D E D BY I N F O R M A T I O N F U R N I S H E D BY T H E L E N D E R , A N D
R E G I S T R A N T S M U S T K E E P T H E M S E L V E S I N F O R M E D A S T O C H A N G E S IN T H E S E
"LISTED ARTICLES".
PASSENGER AUTOMOBILES
AIRCRAFT
MOTOR BOATS A N D BOAT MOTORS
MOTORCYCLES A N D MOTOR BICYCLES
REFRIGERATORS A N D ICEBOXES
WASHING OR IRONING MACHINES
VACUUM CLEANERS
COOKING STOVES
HEATING STOVES A N D HEATERS
ELECTRIC DISHWASHERS
AIR CONDITIONING EQUIPMENT
SEWING MACHINES
RADIOS AND PHONOGRAPHS
METAL MUSICAL INSTRUMENTS
FURNACES, OIL OR GAS BURNERS, A N D STOKERS
WATER HEATERS A N D PUMPS
PLUMBING AND SANITARY FIXTURES
ATTIC VENTILATING FANS
NEW HOUSEHOLD FURNITURE, BED SPRINGS AND
MATTRESSES
PIANOS AND ELECTRIC ORGANS
MATERIALS AND SERVICES USED IN CONNECTION
WITH REPAIRS, ALTERATIONS, OR IMPROVEMENTS OF BUILDINGS
WARNING
Regulation W provides that no borrower shall willfully make any material misstatement or omission
in his Statement. The law under which the President's Executive Order was issued reads in part: "Whoever willfully violates any of the provisions of this subdivision or of any license, order, rule or regulation
issued thereunder, shall, upon conviction, be fined not more than $10,000, or, if a natural person, may be
imprisoned for not more than ten years, or both; and any officer, director, or agent of any corporation who
knowingly participates in such violation may be punished by a like fine, imprisonment, or both."
@FedFRASER