Transcription of PATRIOT ACT INFORMATION DISCLOSURE
1 PATRIOT ACTINFORMATION DISCLOSUREA pplicant NameCo-Applicant NamePresent AddressMailing AddressTo help the government fight the funding of terrorism and money laundering activities, Federal law requires all financialinstitutions to obtain, verify, and record INFORMATION that identifies each person who opens an this means for you: When you open an account, we will ask for your name, address, date of birth, and otherinformation that will allow us to identify you. We may also ask to see your driver's license or other identifying acknowledge that I/we received a copy of this Form 04/04 Organization, or EntityIdentification DocumentationPatriot ActThe USA PATRIOT Act requires all financial institutions to obtain, verify and record INFORMATION that identifies every of this documentation is required in order to comply with the USA PATRIOT Act.
2 A completed copy of thisinformation must be retained with the loan NumberDateOrganization or Entity's NameBorrower's NameDoing Business AsType of Organization or EntityOrganization or Entity's Physical AddressOrganization or Entity's Mailing AddressOrganization or Entity Identification DocumentationDocument TypeOther Document TypeDocument NumberTaxIdentification NumberIssue DateExpiration DateIssued byDiscrepancies and ResolutionCompleted byCalyx Form (4/04) Identification DocumentationPatriot ActThe USA PATRIOT Act requires all financial institutions to obtain, verify and record INFORMATION that identifies every of this documentation is required in order to comply with the USA PATRIOT Act. A completed copy of thisinformation must be retained with the loan NumberDateName of ApplicantSocial Security #Date of BirthPresent AddressMailing AddressPrimary Identification DocumentationDocument TypeOther Document TypeDocument NumberIssue DateExpiration DateIssued bySecondary Identification DocumentationDocument TypeOther Document TypeDocument NumberIssue DateExpiration DateIssued byDiscrepancies and ResolutionCompleted byCalyx Form (4/04) Identification DocumentationPatriot ActThe USA PATRIOT Act requires all financial institutions to obtain, verify and record INFORMATION that identifies every of this documentation is required in order to comply with the USA PATRIOT Act.
3 A completed copy of thisinformation must be retained with the loan NumberDateName of ApplicantSocial Security #Date of BirthPresent AddressMailing AddressPrimary Identification DocumentationDocument TypeOther Document TypeDocument NumberIssue DateExpiration DateIssued bySecondary Identification DocumentationDocument TypeOther Document TypeDocument NumberIssue DateExpiration DateIssued byDiscrepancies and ResolutionCompleted byCalyx Form (4/04)
