Patriots Act Disclosure Borrower Identification
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1Patriots Act Disclosure
Borrower Identification
To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to
obtain, verify and record information that identifies each person who opens an account.
Please provide the following information. We required two forms of identification for each borrower to comply with Section 326
of the Act.
Borrower’s Name
Loan Number
Address
Date of Birth
City, State Zip
Social Security #/Tax ID #
IMPORTANT - Information listed below must be exactly as indicated on the document.
Primary Forms of Identification - must display Borrower’s name
Document
Country/State of
ID Number
Date of Birth
Expiration Date
Origin
State Issued Driver License
State Issued ID Card
Military ID Card
Passport
US Alien Registration Card
Canadian Driver License
Secondary Forms of Identification-must display Borrower’s name
Document
Name of Issuer on
ID Number
Issuance Date
Expiration Date
Form
Social Security Card
U.S. Govt.
Government Issued Visa
Birth Certificate
Non-US/Canadian Driver License
Most Recent Signed Tax Returns
Fed
State
TIN:
Property Tax Bill
APN:
Voter Registration Card
Organizational Membership Card
Bank/Investment/Loan Statements
Paycheck stub with name
Most Recent W-2
Home/car/renter insurance papers
Recent utility bill
Comments:
I certify that I have personally viewed and accurately recorded the information from the documents identified above, and have
reasonably confirmed the identity of the applicant.
Signature
Title
Printed Name
Date
* For persons without a SSN/TIN, the ID number must be from one of the following: passport, alien ID card, or any other government
issued document evidencing nationality or residence and bearing a photograph or similar safeguard.
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