Legal Patriot Act Notice

LEGAL PATRIOT ACT NOTICE

This Legal Patriot Act Notice (the "Notice") is made between Company Name: and Client Name: (each a "Party" and collectively the "Parties") as of the Effective Date: .

RECITALS

WHEREAS, federal law requires certain financial institutions and covered persons to implement Customer Identification Programs, verify the identity of customers, and maintain records of identification and related documentation; and

WHEREAS, the Parties desire to ensure compliance with applicable anti-money laundering and counter-terrorism financing requirements, and Client acknowledges that provision of accurate identification and certification information is a condition to the establishment or continuation of the Parties' relationship; and

WHEREAS, the Parties intend by this Notice to set forth the information required, the certifications to be made by Client, and the Parties' respective rights and obligations regarding verification, recordkeeping, and disclosure under applicable law.

NOW, THEREFORE

In consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the Parties agree as follows:

1. PURPOSE AND SCOPE

1.1 Purpose. The purpose of this Notice is to notify Client of identification and verification requirements imposed by applicable anti-money laundering and counter-terrorism financing statutes and regulations, to obtain Client's representations and certifications, and to obtain Client's authorization for verification and record retention as provided herein.

1.2 Scope. This Notice applies to Client with respect to opening accounts, transacting business, or otherwise establishing a relationship with Company that requires identification or verification under applicable law.

2. CUSTOMER INFORMATION AND CERTIFICATIONS

Day:   Month:   Year:

3. ENTITY STATUS AND BENEFICIAL OWNERS

3.1 Entity Type. Check the box that best describes Client's entity status:

Individual   Corporation   Limited Liability Company (LLC)   Partnership   Trust   Other

3.2 Certification. Client certifies, under penalty of law, that the information provided in this section and any attached documentation is true, complete, and correct to the best of Client's knowledge, and acknowledges that Company may require additional documentation to verify beneficial ownership and control as required by law.

4. ACCEPTABLE IDENTIFICATION DOCUMENTS

4.1 Client must present at least one primary form of government-issued identification and, where applicable, organizational formation documents. The following are common acceptable documents; Company may request originals or certified copies:

U.S. Passport
State Driver's License or State ID
Foreign Passport
Certificate of Incorporation / Formation Documents
Other (describe below)

5. AUTHORIZATION TO VERIFY AND DISCLOSE

5.1 Client expressly authorizes Company and its agents to obtain, verify and retain information about Client from third parties, including consumer reporting agencies, government agencies, or other sources, as necessary to satisfy verification, recordkeeping, and anti-money laundering obligations. Client further authorizes Company to share Client's identification information with other financial institutions or government authorities when required by law or reasonably necessary to verify identity or investigate suspicious activity.

Authorization: I authorize Company to verify and share the information described in this Notice as permitted by law.

6. RECORDKEEPING AND RETENTION

Company will retain copies of identification documentation, records of verification, and this Notice for the period required by applicable law. Client acknowledges that Company may retain copies of documents and records in paper or electronic form and may destroy originals consistent with Company policy and legal requirements.

7. REPRESENTATIONS, WARRANTIES AND INDEMNITY

7.1 Representations and Warranties. Client represents and warrants that all information and documentation provided to Company in connection with this Notice is true, accurate, complete and not misleading. Client will promptly notify Company of any change to the information provided.

7.2 Indemnity. Client agrees to indemnify, defend and hold harmless Company and its affiliates, officers, directors, employees and agents from and against any claims, losses, liabilities, damages, costs and expenses (including reasonable attorneys' fees) resulting from Client's breach of the representations, warranties or obligations under this Notice, including inaccurate or fraudulent information provided by Client.

8. NOTICES

Notices will be effective upon receipt when delivered by hand, courier, or mailed by certified mail to the addresses provided above, unless another address is provided in writing.

9. MISCELLANEOUS

Governing Law. This Notice shall be governed by and construed in accordance with the laws of the State specified by Company at the time of execution, without regard to conflict of laws principles.

Entire Agreement. This Notice constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, whether written or oral, relating to that subject matter.

Severability. If any provision of this Notice is held to be invalid, illegal or unenforceable, the remaining provisions shall continue in full force and effect.

Amendments and Waiver. No amendment or waiver of any provision of this Notice shall be effective unless in writing and signed by both Parties. No failure or delay by either Party to exercise any right shall operate as a waiver of that right.

Counterparts. This Notice 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.

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