| ID Verification Form - Discover

1 2020 Discover Bank, Member FDIC | ID Verification Form Section 1: Discover Bank Applicant or Customer Identify Verification Acknowledgement To be completed by the Discover Bank applicant or customer By signing this form in the presence of a licensed notary, you acknowledge that you applied for or have a deposit account with Discover Bank and any information you provide will be used for Verification . Printed name as it appears on your application/account: _____ Applicant/Customer Signature: _____ Toda\ s Date: ____ / ___/ _____ Best Contact Phone Number: _____ Section 2: Identification Details To be completed by the Bank Notary / Embassy Representative / Military Legal Office Representative Instructions: Please document the applicant/customer s identification detail.

2 Type of ID: _____ Acceptable IDs include: DriYer s License, State ID, Visa, Pass port, or other State Government issued ID Name as it appears on the ID: _____ ID Number: _____ State or Country of Issuance: _____ Issue Date: ____ / ___/ _____ Expiration Date: ____ / ___/ _____ Date of Birth: ____ / ___/ _____ Section 3: Notarizing Officer/Signature Guarantor Information & Stamp Name of Notarizing Officer/Signature Guarantor: _____ Notary Commission/Identification Number: _____ Name of Business/Other: _____ Street Address: _____ City, State, & ZIP Code: _____ Direct Business Phone Line: _____ Notarizing Officer Signature: _____ Place Notary Stamp/Signature Guarantee Stamp below and/or attach any applicable documents Note: If the individual resides in California, please provide a Signature Guarantee.

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