Application Form For Short Term Investment Fund (Stif) Account printable pdf download

Application Form For Short Term Investment Fund (Stif) Account

Department of State Treasurer

Application for Short Term Investment Fund (STIF) Account

Applying Entity:

Statutory Authority for participation in STIF:

____ G.S. 147-86.11(e)(1a); or _____G.S. 147-69.3(b); or ____ G.S. 116-36.1

(Required)

(Voluntary)

(University)

Type of Entity:

_____ State Agency

_____ Local Education Agency

______Community College

______University

_____ Commission/Board -- G.S. reference: _________________________________

_____ Other -- with a State employee/official being the custodian (e.g., association or foundation)

If “Other,” name of Chief Fiscal Officer of the related State agency / college:

(An accompanying letter from the Chief Fiscal Officer is required verifying the relationship and authorizing the account.)

Custodian (Applying Entity)

Primary Contact (For statements and advices)

Name:

Title:

Address:

Tel:

Fax:

Tel:

Fax:

E-mail:

Security Administrator for CB$ (Online Banking System)

Name:____________________________________ Tel: _____________________ E-mail: ______________________________

Name(s) of individual(s) to be executing signature card:

Name (typed):____________________________________________ Title:___________________________________________

Accounting:

Are the funds included in the State’s Comprehensive Annual Financial Report (CAFR)? ____(Yes/No)

If “No” in which entity’s annual financial report are the funds included?

Certification by Custodian (Applying Entity):

I certify that the information contained herein is correct.

___________________________________________________

Name (Type or Print)

Signature

___________________________________________________

Title

Date

For use by the Department of State Treasurer:

STIF Account Number: __________________________ (Assigned by Banking)

Date:_____________ ______________

Flexcube Customer ID Number: ___________________ (Setup on Flexcube)

Date:_____________ ______________

Copy of this application provided to the Office of State Controller (for CAFR purposes) Date:_____________ ______________

North Carolina Department of State Treasurer

Revised 7/2003

Banking Operations Section

325 North Salisbury Street

Raleigh, NC 27603-1385

Application Form For Short Term Investment Fund (Stif) Account

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