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The 440 3640A Oregon form is an Irrevocable Standby Letter of Credit used in the context of workers' compensation for self-insured employers in Oregon. This form ensures that the Oregon Department of Consumer and Business Services has a reliable source of funds to cover any liabilities or obligations that may arise. If you need to fill out this form, click the button below.

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Content Overview

The 440 3640A Oregon form, known as the Irrevocable Standby Letter of Credit, plays a crucial role in the state's workers' compensation framework. This form serves as a financial guarantee from a bank to the Oregon Department of Consumer and Business Services, ensuring that self-insured employers meet their workers' compensation liabilities. By outlining specific conditions under which the letter of credit can be drawn upon, the form provides a structured approach to safeguarding the interests of workers and the state. Key elements include the issuing bank's details, the amount guaranteed, and the various scenarios that allow the Oregon Department to call upon the credit, such as default in payment or bankruptcy. Importantly, the letter is designed to be automatically extended unless the bank provides timely notice of non-renewal, ensuring continuous protection. The form not only specifies the obligations of the issuing bank but also delineates the procedures for drawing funds, emphasizing the importance of compliance with both state laws and international practices. Understanding the intricacies of this form is essential for self-insured employers, banks, and state officials alike, as it underpins the financial stability of the workers' compensation system in Oregon.

Irrevocable Letter of Credit (ILOC): Similar to the 440 3640A form, an ILOC serves as a guarantee of payment from a bank to a beneficiary. It ensures that funds will be available when certain conditions are met, just like the standby letter of credit in Oregon.
Performance Bond: This document guarantees that a contractor will fulfill their obligations under a contract. Like the 440 3640A form, it provides security to the beneficiary in case of default.
Surety Bond: A surety bond involves three parties: the principal, the obligee, and the surety. It ensures that the principal will meet their obligations, similar to how the 440 3640A form protects the Oregon Department of Consumer and Business Services.
Bank Guarantee: A bank guarantee is a promise from a bank to cover a loss if a party defaults. It operates similarly to the standby letter of credit, ensuring payment under specified conditions.
Collateral Agreement: This document secures a loan or obligation with collateral. It provides assurance to the lender, much like how the 440 3640A form secures workers' compensation liabilities.
Letter of Indemnity: A letter of indemnity protects one party from potential losses or damages caused by another. It shares the purpose of providing security, akin to the protections offered by the 440 3640A form.
Escrow Agreement: An escrow agreement involves a third party holding funds until certain conditions are met. This is similar to how the 440 3640A form ensures that funds are available for workers' compensation obligations.
Credit Insurance Policy: This policy protects lenders against borrower default. Like the 440 3640A form, it provides a layer of security for financial transactions.
New Jersey Promissory Note: This essential legal document outlines the borrower's commitment to repay the lender a specified amount, often with interest, by a set date, ensuring clarity in both personal and business transactions. For more details, you can visit promissoryform.com/blank-new-jersey-promissory-note.
Financial Guarantee Insurance Policy: This insurance guarantees the payment of debt obligations. It functions similarly to the standby letter of credit by ensuring that the beneficiary will receive payment if the principal defaults.

State of Oregon

Department of Consumer and Business Services

Workers’ Compensation Division

IRREVOCABLE STANDBY LETTER OF CREDIT

(Form A)

Issuing bank name/address:		Irrevocable Standby Letter of Credit number:
		Effective date:
		Effective date:

Date and place of issue:		Expiry date and place for presentation of documents:
Date:		Expiry date:
Place:		Place for presentation:

Applicant (self-insured employer) name/address:		Beneficiary:
		State of Oregon acting by and through, the
		Oregon Department of Consumer and Business Services
		350 Winter Street NE
		P.O. Box 14480
		Salem, OR 97309-0405

Confirming bank name/address:	Reference number:	Amount: U.S. $ (spell out amount in U.S. dollars)

(hereinafter referred to as “Issuer”) hereby issues our irrevocable standby letter of

[Insert bank name]

credit (hereinafter referred to as “letter of credit”) in favor of the Oregon Department of Consumer and Business Services, on behalf of (hereinafter referred to as the “self-insured employer”)

(applicant)
in the amount of U.S. dollars:		.
The credit is available with
		(issuing or confirming bank located in the state of Oregon)

by presentation of the beneficiary’s draft drawn at sight on the issuing bank or confirming bank, payable within three business days, when accompanied by one of the four following statements, signed by the director of the Oregon Department of Consumer and Business Services or the administrator of the Oregon Department of Consumer and Business Services, Workers’ Compensation Division, or their designated authorized representative:

That the self-insured employer has defaulted in payment of its workers’ compensation liabilities or obligations, or in payments due the director of the Oregon Department of Consumer and Business Services; OR

That the self-insured employer has filed for bankruptcy; OR

That the self-insured employer has failed to renew the letter of credit or substitute acceptable security for workers’ compensation liabilities and obligations by fifteen (15) days before the expiry date of the letter of credit; OR

That the beneficiary has determined that the existing security is deemed to be inadequate; that additional or replacement security must be provided by the self-insured employer and that neither has been provided, notwithstanding written notice to the self-insured employer.

This letter of credit is payable at:

Drawings honored by the issuing bank or confirming bank under this letter of credit shall not, in the aggregate, exceed the total amount of credit set forth above, or as modified by accepted amendments, and each drawing honored by the issuing bank or confirming bank shall reduce the amount set forth pro tanto. Partial drawings are permitted.

440-3640a (8/06/DCBS/WCD/WEB)

Letter of Credit Number

Page 2

The purpose of this letter of credit is to create a primary obligation on the part of

(issuing bank)

and any confirming bank to the Oregon Department of Consumer and Business Services relating to the self-insured workers’ compensation liabilities and obligations of the self-insured employer

(applicant)

in accordance with Chapter 656 of the Oregon Revised Statutes. Except as stated herein, this letter of credit is not subject to any condition or qualification and is the issuing and any confirming bank’s individual obligation which is in no way contingent upon reimbursement, and shall cover all of the certified self-insured employer’s past, present, existing, and potential liability up to the total amount of credit set forth above for assessments, contributions, or other obligations due from the certified self-insured employer to the Oregon Department of Consumer and Business Services, Workers’ Compensation Division.

This letter of credit will be automatically extended without amendment for one year from the expiry date shown above, or any future expiry date, unless at least 60 days prior to expiry, we notify the beneficiary by registered mail or overnight delivery that we elect not to extend this letter of credit for such additional period. The notification will be addressed to the Administrator, Workers’ Compensation Division, Department of Consumer and Business Services, State of Oregon, 350 Winter Street NE, P.O. Box 14480, Salem, OR 97309-0405.

Payment of any amount under this letter of credit by the issuing or a confirming bank shall be made by wire transfer to the Oregon Department of Consumer and Business Services’ bank account, as instructed in the demand notice signed by the director or the administrator or their designated authorized representative, for deposit to the account of the Oregon Department of Consumer and Business Services for the self-insured employer’s workers’ compensation liabilities and obligations under ORS 656.

If the issuing bank or any confirming bank is closed at the time of the expiry of this letter of credit for any reason that would prevent the delivery of a demand notice during its normal hours of operation, this letter of credit will be automatically extended for a period of 30 days commencing on the next day of operation.

All bank charges for this letter of credit are for the account of the applicant.

Any amendments to this letter of credit must be approved by the beneficiary.

Except so far as otherwise expressly stated, this letter of credit is subject to the International Standby Practices 1998 (ISP 98) International Chamber of Commerce Publication # 590 and to the laws of the state of Oregon. In the event of a conflict between these authorities, the laws of the state of Oregon will control.

We hereby engage with drawers, endorsers, and/or bona fide holder that drafts drawn under and presented in strict conformity with the terms of this credit will be duly honored on presentation to us.

The funds provided by this letter of credit are not construed to be an asset of the self-insured employer. If any legal proceedings are initiated with respect to this letter of credit, it is agreed that such proceedings shall be subject to the courts and law of the state of Oregon.

	is requested to add its confirmation to this letter of credit.
(name of confirming bank or N/A)
Issuing bank
Name:		Date:
Title:
Signature:
	hereby undertakes to honor any drafts presented to it when
(name of confirming bank or N/A)
drawn under and in strict conformity with the terms of this credit.
Confirming bank
Name:		Date:
Title:
Signature:
Accepted by the Oregon Department of Consumer and Business Services
Name:		Date:
Title:
Signature:
440-3640a (8/06/DCBS/WCD/WEB)

Filling out and using the 440 3640A Oregon form requires careful attention to detail. Here are some key takeaways to keep in mind:

Understand the Purpose: This form serves as an Irrevocable Standby Letter of Credit, ensuring that self-insured employers can meet their workers' compensation obligations.
Complete Bank Information: Clearly provide the issuing bank's name and address, as well as the confirming bank's details if applicable.
Specify the Amount: Indicate the total amount of the letter of credit in U.S. dollars, both numerically and spelled out.
Identify the Beneficiary: The beneficiary is the State of Oregon, specifically the Oregon Department of Consumer and Business Services.
Draft Presentation: Drafts must be presented to the bank and marked correctly to ensure they are honored.
Automatic Extensions: The letter of credit will automatically extend for one year unless the bank notifies the beneficiary at least 60 days before the expiry date.
Bank Charges: All associated bank charges are the responsibility of the applicant (self-insured employer).
Legal Compliance: This letter of credit is subject to Oregon state law and the International Standby Practices 1998, ensuring that it meets legal requirements.

By following these guidelines, you can effectively navigate the process of completing and utilizing the 440 3640A form.

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Fact Name	Description
Form Purpose	This form is used to create an irrevocable standby letter of credit for self-insured employers in Oregon.
Governing Law	The letter of credit is governed by Chapter 656 of the Oregon Revised Statutes.
Beneficiary	The beneficiary is the Oregon Department of Consumer and Business Services.
Issuing Bank	The form requires details about the issuing bank, including its name and address.
Expiration Terms	The letter of credit automatically extends for one year unless the issuing bank notifies the beneficiary at least 60 days prior to expiration.
Payment Method	Payments under the letter of credit must be made by wire transfer to the Oregon Department of Consumer and Business Services’ bank account.
Conditions for Drawing	Funds can be drawn if specific conditions are met, such as default in payment or bankruptcy.
Partial Drawings	Partial drawings against the letter of credit are permitted, allowing flexibility for the self-insured employer.
Bank Charges	All bank charges related to the letter of credit are the responsibility of the applicant.
Legal Proceedings	Any legal proceedings regarding the letter of credit will be subject to the courts and laws of Oregon.

(branch of bank, name and address)

. Drafts presented must be marked

“Drawn under

(issuing bank)

letter of credit number

The 440 3640A Oregon form, known as the Irrevocable Standby Letter of Credit, is essential for self-insured employers in Oregon to secure their workers' compensation obligations. Along with this form, several other documents may be required to ensure compliance and proper management of workers' compensation liabilities. Below is a list of related forms and documents commonly used in conjunction with the 440 3640A.

Form 440-3641: This form is used to request the release of the letter of credit once the self-insured employer has fulfilled its obligations. It ensures that the security is returned in a timely manner.
Form 440-3642: This document serves as a notice of change in the self-insured employer's status, such as a change in ownership or business structure. It must be filed to keep the Oregon Department of Consumer and Business Services informed.
Motorcycle Bill of Sale: For those dealing with motorcycle transactions, utilizing the Forms Georgia can provide essential documentation to ensure the legal transfer of ownership.
Form 440-3643: This form is used to report any changes in the financial condition of the self-insured employer. It is crucial for maintaining transparency and compliance with state regulations.
Form 440-3644: This document is a request for an extension of the letter of credit. If the self-insured employer needs more time to secure alternative arrangements, this form must be submitted to the appropriate authorities.
Form 440-3645: This form is utilized to amend the terms of the existing letter of credit. Any changes in the amount or conditions must be documented to ensure clarity and compliance.
Form 440-3646: This document is a notification of bankruptcy, which must be filed if the self-insured employer enters bankruptcy proceedings. It alerts the Oregon Department of Consumer and Business Services to potential liabilities.
Financial Statements: Recent financial statements may be required to assess the self-insured employer's ability to meet its obligations. These documents provide a snapshot of the company's financial health.
Certificate of Insurance: This certificate verifies that the self-insured employer has adequate insurance coverage for workers' compensation liabilities. It is a crucial part of maintaining compliance with state regulations.
Annual Report: An annual report detailing the self-insured employer's workers' compensation claims and liabilities may be required. This helps the Oregon Department of Consumer and Business Services monitor compliance and financial stability.

These forms and documents work together to ensure that self-insured employers meet their workers' compensation obligations effectively. Proper management of these requirements is essential for maintaining compliance and protecting the interests of both the employer and the employees.