Introductory BSA/AML Examiner School, Atlanta, CA

Use For: A/N A/N

BANK SECRECY ACT

CUSTOMER IDENTIFICATION PROGRAM

A/N

As part of the USA Patriot Act signed into law in 2001, we are required to identify our customers. The Customer Identification Program regulation objective is for the Trust company to attain a reasonable belief that it knows the true identity of the person opening the account and to verify the

identification. FIRST NAME

MI

LAST NAME

ADDRESS CITY

STATE

ZIP CODE

TELEPHONE NO. (H)( )

(W) ( )

SS#

DATE OF BIRTH

OCCUPATION

EMPLOYER

Is this account for a Director, Officer or Employee of the Bank?  NO Are you or any of your relatives or associates connected to the government of any country?  YES  NO If Yes, indicate if relative, if associate list name, if connected with government indicate which country:  YES

COMPLETE ONE OF THE FOLLOWING 1. PRIMARY ID:  Driver’s License

Foreign customers – Passport and either:  I-551 – Resident Alien (Green Card)  I-94 – Non-Resident Alien

 Passport  Military ID

 State ID

VALID PRIMARY ID#

STATE/COUNTRY

ISSUE DATE

EXPIRATION DATE

OR

2. ALTERNATE ID:

 SS CARD

 MEDICARE

 MEDICAID

 OTHER

CARD NUMBER:

AND TWO (2) BILLS WITH CUSTOMER’S NAME AND ADDRESS (Only one (1) if current customer): BILL COMPANY BILL TYPE

(ex. Water, gas, etc.)

(ex. Water, gas, etc.)

BILL COMPANY

BILL TYPE

SECURITY/IDENTIFICATION QUESTIONS

QUESTION #1

ANSWER

QUESTION #2

ANSWER

QUESTION #3 ANSWER Example Questions: Favorite Book. Pet peeve. Name of favorite pet. Grandfather’s name. Best friends last name. Grandmother’s name. Etc. Security Questions and answers have been added to Goldmine under Detail / Notes Date completed

Completed By:___________________________________________________________ Date:_________________________________________

NOT REQUIRED FOR BSA – INTERNAL USE ONLY

EMAIL ADDRESS STATEMENTS  PAPER  ONLINE FREQUENCY

 MONTHLY  QUARTERLY  ANNUALLY