Patriot Act Disclosure Template - Important Applicant Information printable pdf download

Patriot Act Disclosure

Important Applicant Information

Borrower Name(s)____________________________________________________________________________Lender Name________________________________________

Property Address_________________________________________________________________________________________________________Date______________________

Important Information about Procedures for Requesting a Loan

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 request a loan.

To comply with the U.S. Patriot Act, your lender is required to verify the identity of all applicants applying for and opening new accounts.

In addition to the information requested on your loan application, please include your date of birth and mailing address as follows:

Date of Birth (for all applicants):

Name___________________________________________________________________________Date of Birth_______________________________________________________

Mailing Address for each applicant, if different: (if differs from the property address)

_______________________________________________________________________________________________________________________________________________________

We also require being able to verify and copy your valid state driver’s license or one of the other identifying documents listed below prior to

you executing your closing documents:

•

VALID PASSPORT

•

MILITARY OR DEPENDANT ID

•

VALID STATE ID

•

WELL KNOWN COMPANY ID WITH PHOTO AND PAY STUB FROM MOST RECENT PAY PERIOD

•

CURRENT SCHOOL ID WITH PHOTO

•

BIRTH CERTIFICATE

•

U.S. DEPARTMENT OF HOMELAND SECURITY ALIEN REGISTRATION RECEIPT CARD-“GREEN CARD”

•

BANK CREDIT CARD WITH PHOTO (I.E. VISA, MASTERCARD, ETC.)

Borrower Signature______________________________________________________________________________________Date______________________________________

BROKER TO COMPLETE

For Office Use Only:

Identification Document Name__________________________________________________

Document Number______________________________ Expiration Date________________

Place of Issuance_______________________________ Date of Issuance________________

I, ______________________________, certify that the attached document has been verified.

(Please Print Name)

Signature: ___________________________________ Date_________________________

Patriot Act Disclosure Template - Important Applicant Information

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