FORM OF CERTIFICATION
I ACKNOWLEDGE THAT THIS SECURITY IS NOT A DEPOSIT OR ACCOUNT AND IS NOT FEDERALLY INSURED, AND IS NOT GUARANTEED BY [insert name of savings association] OR BY THE FEDERAL GOVERNMENT.
If anyone asserts that this security is Federally insured or guaranteed, or is as safe as an insured deposit, I should call the Office of the Comptroller of the Currency.
I further certify that, before purchasing the [description of security being offered] of [name of issuer, name of savings association and affiliation to issuer (if different)], I received an offering circular.
The offering circular that I received contains disclosure concerning the nature of the security being offered and describes the risks involved in the investment, including:
[List briefly the principal risks involved and cross reference certain specified pages of the offering circular where a more complete description of the risks is made.]
Signature: _______________________________
Date:_______________________________
12 C.F.R. §163.76