Can the form be signed electronically?

Yes where permitted: electronic signatures that meet ESIGN (15 U.S.C. §7001) and state UETA standards are acceptable for CIP records. Note exceptions for certain court or testamentary documents; always confirm whether paper, notarization, or additional identity proofing is required.

What identification documents are acceptable?

Accept commonly issued government IDs such as a passport or state driver license. Record issuing jurisdiction, ID number, and expiration date; unexpired government ID is preferred for reliable verification.

What if the applicant refuses to provide SSN or TIN?

If a taxpayer ID is refused or unavailable, follow institution policy for alternative identity verification or decline account opening. Incomplete verification may require escalation to compliance and may result in account denial.

Is notarization required for this form?

Not typically required for CIP itself, but some institutions or state rules may ask for notarization or remote online notarization (RON) for specific account types; RON rules vary by state and often require recorded sessions and identity proofing.

How long must supporting ID copies be kept?

Keep copies per retention policy: at least 5 years after account closure for CIP records (FinCEN), longer where state or industry rules require it. Ensure secure, auditable storage with access controls.

What happens if name or document info doesn't match?

Resolve mismatches before account opening: obtain corrected documents, secondary ID, or additional verification. Unresolved discrepancies may trigger enhanced due diligence or account denial under 31 U.S.C. §5318(l).

Electronic Signature
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Legal
Legal Patriot Act Information Form

Legal Patriot Act Information Form

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LEGAL PATRIOT ACT INFORMATION FORM

This Legal Patriot Act Information Form (the "Form") is executed by Client Name: and Institution Name: on .

RECITALS

WHEREAS, the Institution is required to collect and verify information from persons and entities in order to comply with the USA PATRIOT Act and related anti-money laundering and counter-terrorist financing requirements;

WHEREAS, the Client seeks to establish or maintain a business relationship or account with the Institution and must provide identification and certification information sufficient for the Institution to perform customer identification and verification procedures;

WHEREAS, the parties desire to set forth the information and certifications required for regulatory compliance and for the Institution to retain records in accordance with applicable law;

NOW THEREFORE

In consideration of the mutual covenants contained herein and for other good and valuable consideration, the parties agree as follows.

1. CUSTOMER IDENTIFICATION INFORMATION

Full Legal Name Any Other Names Used (aliases, DBA) Date of Birth Social Security Number or Taxpayer Identification Number Residential Address Mailing Address (if different)

Primary Phone

Email Address

2. ENTITY TYPE

Please indicate the Client's legal classification:

Entity Type (check all that apply) Individual Corporation Limited Liability Company (LLC) Partnership Trust Government Entity Other:

3. IDENTIFICATION DOCUMENTATION

Provide at least one government-issued identification document. Check the document(s) provided and complete the associated fields.

Driver's License / State ID

Document Number Issuing State Expiration Date

U.S. Passport

Passport Number Expiration Date

Foreign Passport

Passport Number Issuing Country Expiration Date

Other Identification

4. BENEFICIAL OWNERS / CONTROLLING PERSONS

If the Client is a legal entity, list each beneficial owner or controlling person (name, title, ownership percentage, date of birth, identifying document provided). Attach additional sheets if necessary.

5. CERTIFICATION AND CONSENT

The Client certifies, represents and warrants to the Institution as follows:

The information and documentation provided in this Form and any attachments are true, complete and correct to the best of the Client's knowledge and belief. The Client will promptly notify the Institution of any material change in such information.
The Client authorizes the Institution to obtain such verification as required to satisfy customer identification program obligations, including but not limited to verification through third-party service providers, public records, credit reporting agencies and other lawful sources. The Client consents to such inquiries and releases the Institution and its agents from liability for conducting such verification.
The Client acknowledges that the Institution is required by law to retain records of identification and verification and to report suspicious activity to appropriate regulatory authorities where legally required. The Client understands that the Institution may refuse or terminate the business relationship if the Client fails to provide satisfactory information or if the Institution is unable to verify the Client's identity.
The Client agrees to indemnify, defend and hold harmless the Institution against any loss, cost or liability arising from false or misleading information provided by the Client or from the Client's failure to disclose required information.

6. USE, RETENTION AND CONFIDENTIALITY

The Institution will retain records and documentation collected pursuant to this Form for the period required by applicable law. The Institution will treat information provided as confidential and will disclose such information only as required by law or regulation or as otherwise permitted by written agreement between the parties.

7. NOTICES

Institution Notice Address Client Notice Address

All notices under this Form shall be in writing and delivered to the addresses above by hand, certified mail, or other commercially reasonable means and shall be effective upon receipt.

8. MISCELLANEOUS

Governing Law: This Form shall be governed by and construed in accordance with the laws of the jurisdiction specified by the Institution as the governing forum for the business relationship, without regard to principles of conflicts of law.

Entire Agreement: This Form constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements and understandings, whether written or oral, relating to the same subject matter.

Severability: If any provision of this Form is held to be invalid, illegal or unenforceable, the remaining provisions shall remain in full force and effect and the invalid provision shall be reformed only to the extent necessary to make it enforceable.

Amendments and Waiver: Any amendment or waiver of any provision of this Form must be in writing and signed by both parties. No failure or delay in exercising any right shall operate as a waiver of that right.

Counterparts: This Form may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

9. ACKNOWLEDGMENT

By signing below, the undersigned certifies under penalty of perjury that the information provided in this Form is true, correct and complete, and that the undersigned is authorized to provide the foregoing information and documentation on behalf of the Client.

Client:

By:

Date:

Institution:

By:

Date:

What the Legal Patriot Act Information Form Is

The Legal Patriot Act Information Form is a standardized customer identification and data-collection form used to satisfy customer identification program (CIP) and anti-money laundering requirements under the USA PATRIOT Act and implementing FinCEN rules. It collects verifiable identity data — full legal name, date of birth, taxpayer identification, residential address, government ID type and number, and signature — and documents the steps an institution took to verify identity. Institutions keep the form and supporting ID records as part of regulatory recordkeeping and to support audits, investigations, and suspicious-activity reporting obligations.

Why this form matters for compliance and risk control

Completing this form documents lawful identity verification, reduces regulatory risk, and creates an auditable trail for examiners and internal compliance. It supports compliance with 31 U.S.C. §5318(l) (PATRIOT Act CIP obligations), FinCEN implementing regulations, and fits electronic recordkeeping when executed under ESIGN (15 U.S.C. §7001) or state UETA provisions.

Which organizations and people use this form

The Legal Patriot Act Information Form is used by institutions subject to BSA/CIP rules and by individuals or entities when opening regulated accounts or transacting with regulated providers.

Banks and credit unions: Used at account opening and for enhanced due diligence on higher-risk customers.
Money services businesses and fintechs: Collects identity data for digital onboarding and ongoing monitoring obligations.
Broker-dealers and financial intermediaries: Applied when establishing relationships requiring CIP and KYC documentation.

Use of the form helps institutions demonstrate consistent procedures across customer intake, onboarding, and periodic review processes.

Typical signers and responsible parties

Compliance Officer

A designated compliance or AML officer oversees form design, verifies CIP practice, documents verification methods, and retains records for examiner review. They coordinate SAR filings and periodic program reviews when issues arise.

Applicant

The individual or authorized representative completes identity fields, provides required ID documentation, and signs or consents electronically or in person. Accuracy here determines whether the institution can onboard or must decline the relationship.

Step-by-step: complete and verify the form

Follow a consistent sequence to minimize errors: prepare the data, verify identity, capture authorization, and store records.

01

Prepare documents: Gather IDs and supporting records before starting the form.
02

Verify identity: Match names, DOB, and ID numbers against the presented documents or database checks.
03

Capture authorization: Obtain a dated signature or recorded electronic consent showing intent to sign.
04

Retain records: Store the completed form plus copies of ID per retention rules.

How the form moves through your onboarding workflow

A simple digital workflow reduces intake friction: upload, assign, authenticate, then archive with an audit trail.

Upload form: Sender uploads PDF or completes the online template.
Assign signer: Specify applicant and any verifying officer or approver.
Authenticate signer: Use email, SMS, or stronger KBA/MFA for identity assurance.
Store signed record: Archive final PDF and audit log for compliance reviews.

Essential elements of a compliant Patriot Act information form

A professionally prepared form combines mandatory data fields, verification evidence, and secure recordkeeping to satisfy examiners and streamline onboarding while preserving an auditable history.

Identity verification

Include fields to record the specific ID used, issuing authority, expiration, and the verification method (document review, database match, or third-party service) to evidence CIP steps.

Required fields

Capture full legal name, DOB, SSN/TIN, current address, and contact information; these data points are the basis for identity matching and risk-scoring algorithms.

Verification evidence

Document copies, screen captures, or third-party verification reports should be linked to the form and stored to support examiners and potential investigations.

Audit trail

Record timestamps, IP addresses, signer actions, and approver notes to demonstrate who performed each verification step and when.

Secure storage

Retain signed forms and supporting records in encrypted storage with strict access controls and logging to meet regulatory recordkeeping expectations.

Integration options

Design the form for export to case management, AML monitoring, and core account systems to automate periodic review and SAR-related workflows.

Security and compliance controls to record

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest

Certifications: SOC 2 Type II; ISO 27001

Audit Trail: Timestamps, IP, and action logs

HIPAA BAA: Available where PHI is involved

ESIGN / UETA: Meets electronic signature legal tests

Access Controls: Role-based user permissions

Consequences and common compliance risks

Civil fines: Enforcement actions under the BSA

Criminal penalties: Potential prosecution for willful violations

Account denial: Refuse or terminate accounts lacking verification

Reputational harm: Public enforcement damages trust

Operational delays: Onboarding backlogs and higher costs

Regulatory scrutiny: More frequent exams and remediation

Timing: when the form must be completed and updated

Timing expectations emphasize completing identity verification before or at account opening, keeping records current, and maintaining evidence for the regulatory retention period.

Initial verification timing:

Complete CIP verification before or at account opening.

Update on material changes:

Refresh records when customer information changes significantly.

Retention period:

Keep CIP records per FinCEN rules (see retention guidance).

SAR reporting:

File suspicious activity reports promptly per BSA procedures.

Periodic reviews:

Conduct enhanced or periodic reviews for higher-risk customers.

Frequently asked questions and practical answers

Answers below address common completion, signature, and retention questions encountered when administering the Legal Patriot Act Information Form.

Need help? Contact support

Can the form be signed electronically?
Yes where permitted: electronic signatures that meet ESIGN (15 U.S.C. §7001) and state UETA standards are acceptable for CIP records. Note exceptions for certain court or testamentary documents; always confirm whether paper, notarization, or additional identity proofing is required.
What identification documents are acceptable?
Accept commonly issued government IDs such as a passport or state driver license. Record issuing jurisdiction, ID number, and expiration date; unexpired government ID is preferred for reliable verification.
What if the applicant refuses to provide SSN or TIN?
If a taxpayer ID is refused or unavailable, follow institution policy for alternative identity verification or decline account opening. Incomplete verification may require escalation to compliance and may result in account denial.
Is notarization required for this form?
Not typically required for CIP itself, but some institutions or state rules may ask for notarization or remote online notarization (RON) for specific account types; RON rules vary by state and often require recorded sessions and identity proofing.
How long must supporting ID copies be kept?
Keep copies per retention policy: at least 5 years after account closure for CIP records (FinCEN), longer where state or industry rules require it. Ensure secure, auditable storage with access controls.
What happens if name or document info doesn't match?
Resolve mismatches before account opening: obtain corrected documents, secondary ID, or additional verification. Unresolved discrepancies may trigger enhanced due diligence or account denial under 31 U.S.C. §5318(l).

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