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State of New York
Office of the State Comptroller
Division of Pension Investment and Cash Management
REQUEST FOR NEW STATE BANK ACCOUNT
Agency Name:
Agency Code:
Mailing Address:
City:
Zip Code:
Contact Name:
Telephone Number:
E-Mail Address:

Briefly explain the purpose for the new Account:
(include statutory reference if applicable)
Estimated annual dollar amount to be deposited:

Name and branch location of requested depository:
Has the depository agreed to pledge collateral in accordance with NY State guidelines?
Yes No
Are funds deposited into this account required to be transferred to the State Treasury?
Yes No