Customer Identification Documentation Patriot Act
The USA Patriot Act requires all financial institutions to obtain, verify and record information that identifies every customer. Completion of this documentation is required in order to comply with the USA Patriot Act. A completed copy of this information must be retained with the loan file.
Application Number Name of Applicant Social Security # Present Address Mailing Address
Date
07/21/2009
Date of Birth
Primary Identification Documentation Document Type Document Number Issue Date Issued by Expiration Date Other Document Type
Secondary Identification Documentation Document Type Document Number Issue Date Issued by Expiration Date Other Document Type
Discrepancies and Resolution
Completed by
Calyx Form (4/04) BRWIDDoc.frm