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Financial Institution Information Form for Fee Waiver
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By completing this form, you acknowledge that your institution will waive or will continue to waive wire transfer or processing fees in connection with Holocaust reparation payments issued to your customers.
For those institutions who are not regulated by the State of New York, voluntarily waving these fees and being included on the list of institutions published on DFS’s website, does not grant New York State any jurisdiction.
This is an endeavor aimed at informing individuals that they could request such a waiver from their financial institution.
Name of institution
Individual Completing Form
Name
Title
Individual HCPO can contact for questions
Name
Email
Telephone number
Authorization
By checking the box you authorize the NYS Department of Financial Services to include your institution as part of a list, to be published on the Department’s website, of financial entities waiving wire transfer fee costs.
Leave this field blank