Financial Identity Verification Disclosure

FINANCIAL IDENTITY VERIFICATION DISCLOSURE

Issuing Financial Institution

Client Information

Identification Presented

The following identification was provided to establish identity and was used in verification procedures. Check all documents presented and record issuing details.

ID Expiration Date:

Purpose and Legal Basis for Verification

We are required by applicable law and internal policy to verify the identity of persons opening accounts or establishing relationships to prevent fraud, money laundering, financing of unlawful activity and to comply with regulatory obligations. This disclosure describes the categories of information we collect, methods used to verify identity, how information may be used and shared, and your rights.

Information Collected and Sources

Information collected may include name, date of birth, taxpayer identification number, residential address, government-issued identification numbers, and other information necessary to verify identity. Sources of information may include:

• Documents you provide (see above)
• Consumer reporting agencies and credit bureaus
• Public records and government databases
• Third-party identity verification vendors and databases

Methods of Verification Performed

The institution may use one or more of the following methods to verify identity. Check all methods used in this instance and describe results where applicable.

Use and Sharing of Verification Information

Information and the results of verification may be used for purposes of account opening, ongoing account monitoring, fraud detection, compliance with law, and loss prevention. Information may be disclosed to service providers engaged to perform identity verification, affiliates for compliance purposes, regulatory and law enforcement bodies as required by law, and to relevant public record repositories. The institution will limit sharing to the minimum necessary to accomplish lawful purposes.

Retention and Recordkeeping

Records, copies of identification documents, and verification results will be retained in accordance with applicable law and institutional policy for compliance, audit and investigative purposes. Records are generally retained for not less than five years or for the period required by applicable statutes and regulations.

Consequences of Declining Verification

If you decline or fail to provide required information or consent to verification, the institution may refuse to open an account, close an existing account, refuse to process transactions, or take other action permitted by law and contract. Declining consent may also limit the institution's ability to provide certain services.

Your Rights and Remedies

You may request a copy of information obtained as part of verification and may dispute and seek correction of any inaccurate information. To initiate a dispute or request additional information, contact the institution representative identified below. The institution will investigate and respond to disputes in accordance with applicable law.

Certification and Consent

By signing below, I certify under penalty of law that the information I have provided is true, accurate and complete to the best of my knowledge. I acknowledge that the institution has disclosed the types of information to be collected and the methods to be used to verify my identity. I authorize the institution to obtain, use and share information (including consumer reports and inquiries to third-party identity verification services) as necessary to verify my identity, to perform due diligence, to prevent fraud, and to comply with applicable law. I further authorize the release of verification results to affiliates and service providers as necessary to accomplish these purposes.

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