Approval of IAT Receiver Form 9.09 by yaoyufang


                       Approval of International ACH Transaction (IAT) Receiver Form
As a value-added service, U.S. Central screens International ACH Transaction (IAT) receivers submitted through the APEX-
ACH system via an automated OFAC filter using the same sensitivity settings that we use for our own transactions. We also
pre-screen foreign receivers at your request. If a pre-screen result produces a hit or if an item produces a hit against the
OFAC SDN and non-SDN lists, we will not process international ACH transactions for this receiver. Any item(s) submitted to
APEX-ACH for this receiver will be returned to you. If you determine the original OFAC hit was a “false hit”, you can authorize
U.S. Central to process international ACH transactions submitted through APEX-ACH for this receiver by completing the
information below. Approvals received at U.S. Central by 6 p.m. CT will apply to items that produced hits that day; otherwise,
the approval will apply to all items for this receiver beginning the following business day.
By completing and submitting this form, you are representing to U.S. Central that you have conducted the necessary
investigation and determined that the receiver specified in the IAT entry that resulted in a hit by the OFAC filter is not a
person specified on either the OFAC SDN or non-SDN lists and are authorizing and directing U.S. Central to process the ACH
item. Note: All previously approved receivers will be re-evaluated each time OFAC updates the SDN and non-SDN lists. This
could result in transactions sent to a previously approved receiver being returned.

     1.   Complete all fields in the sections below.
     2.   Fax the form to payment operations at 913-319-3271.
     3.   Contact the Call Center at (800) 772-2243, opt. 3; someone will be glad to assist you.

Approval of IAT Receiver Form


                 Contact Name:
Contact          Corporate/Credit
Information      Union Name:

                 E-mail address:

                                            OFAC approval for a previous
                 Select one:                                                     OFAC approval for a pre-screen hit
                                         transaction hit
                 PayLinks Code of ODFI                                      Company ID
                 (Also known as Abbrv                                       (CU RT# or
                 Code):                                                     SEG #):
                 File ID (Complete only if
                 this approval is for previous
                 transaction OFAC hit):
                 Batch Sequence #:

IAT Receiver     Receiver Name:
                 Receiver Street Address

                 Receiver City                                                              Receiver State
                                                                                            Receiver Postal
                 Receiver Country
                 RDFI Name
                                                                                            RDFI Branch
                 RDFI ID #
                                                                                            Country Code
                 Foreign Account #

For USC Use              CRM #:
Only:                    Date Approval List of International ACH Receivers updated:
                         Processed by:

                                                                                               Form ver. 08.21.2009

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