IBM Southeast Employees' Federal Credit Union
P.O. Box 5090
Boca Raton, FL 33431-0890
(561) 982-4700 • (800) 873-5100

MEMBER'S NAME

MEMBER'S ADDRESS

ADVERSE ACTION FORM

MEMBER NUMBER

DATE

Dear Member:
We recently reviewed your request for credit, account services, or changes in your account. After careful consideration, the Credit Union has taken the following adverse
action(s) on your application or account:

The principal reason(s) for the above credit decision(s):

If your credit rating is keeping you from your goals, contact BALANCE. In partnership with IBM SOUTHEAST EMPLOYEES' FEDERAL CREDIT UNION, BALANCE provides
free financial education and counseling for Members. A counselor will help you develop a plan of action for improving your credit and budget. Contact BALANCE at 888-456-
2227 or info@balancepro.org.

INFORMATION REQUEST: We request the following information in order to make a decision on your application:

If we do not receive this information by

we will be unable to consider your application.

COUNTER OFFER: We are unable to extend credit/services on the terms you requested for the reason(s) given above, but can offer you credit/services on the following
terms:

and the following conditions:

If this offer is acceptable to you please notify us no later than

Disclosure of use of information obtained from an outside source:

at the address at the top of this notice.

If you have any questions regarding this notice, please contact us at the address or telephone number at the top of this notice. Thank you.

LASER UD FI14759 Rev 8-2011

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COPYRIGHT 2005 Securian Financial Group, Inc. All rights reserved.

If checked, we obtained your credit score from the following consumer reporting agency and used it in making our credit decision. Your
credit  score  is  a  number  that  reflects  the  information  in  your  credit  report.  Your  credit  score  can  change,  depending  on  how  the
information in your credit report changes.

Name of consumer reporting agency:

Your credit score:

Date of score:

Scores range from a low of:

to a high of:

Key factors that adversely affected your credit score:

If checked, the number of inquiries was a key factor adversely affecting your credit score.

If you have questions regarding your credit score, please contact the consumer reporting agency listed at the address and phone number on
page 1.

If you applied for credit with a co-borrower or guarantor whose credit score affected your loan approval, they will receive their own
separate notice.

EQUAL CREDIT OPPORTUNITY ACT NOTICE

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion,
national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the
applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the
Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this credit union is: National
Credit Union Administration, Office of Consumer Protection, 1775 Duke Street, Alexandria, VA 22314. Phone (703) 518-1140;
Fax - (703) 518- 6672; Email-ocpmail@ncua.gov.

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