CONSUMERPROFILE

Whatbroughtyoutothebanktoday?

OpenAccountGatherInformationOther

Wasthisaccountopenedinperson?Yes orNo

If“No,” howwas itopened:

Ifitistoopenanaccount,whattypeofaccount?

CheckingSavings

MoneyMarketAccount Time Deposit (CD)

Loan

Other

Anychanceyouareanexistingcustomerofthebank?YesorNo

Isthecustomerlocal?Yes orNo

If“No,” whydid thecustomerchoosethe bank

Togetyouraccountopened,wearegoingtoneedsomeinformation:

Name:

PhysicalAddress:

MailingAddress:

PhonenumbersHome:

Work:

Cell:

SSN orITIN:

(If no SSN or ITIN, Passport or other identification number)

Occupation: EmailAddress: HouseholdIncome:

Wewillalsoneedtwoformsofidentification:(Attachcopies.DonotphotocopyorscanmilitaryID)

AreyouaUSPerson(USPersonincludesresidentalien)YesorNo

Ifyouareanonresidentalien,whatcountryareyoufrom?

Areyouanelectedofficial?Yes or No

IsanyAuthorizedSigneraPoliticallyExposedPerson(PEP)?Yes or No

APoliticallyExposedPerson(PEP)isanindividualwhoisorhasbeenentrustedwithprominentpublicfunctions,includingaheadofstateorgovernment;seniorpolitician;aseniorgovernment,judicial,ormilitary official; senior executive of a publicly-owned corporation; and important political party official.

If “Yes,” Signer’s Name: CountryAffiliation: andPosition:

Nowtogetyouintherightproduct,wewillneedtoknowhowyouplantousethisaccount?

Household OperatingAccount?Separateaccount forspecial purpose?

Savings

Other

Whereareyoumovingthefundsfrom?

Name of financial institution

Howdoyouplantofundthisaccount?

Cash

Onus transferor checkPayrollcheck Governmentcheck

Cashier’s checkWire

Foreignfunds

Whatisyourexpectedaccountusage?

GeneralPersonalOther:(Specify)

#Deposits /Month(Est)

#Checks Withdrawals/Month(Est)

$Deposits /Month(Est)

$Checks Withdrawals/Month(Est)

DepositCash?Yes/No

IfYES,estimateamount $

PerMonth/PerTransaction

Withdraw Cash?Yes/No

IfYES,estimateamount $

PerMonth/PerTransaction

Purpose:

IncomingWires?Yes/No

IfYES,estimateamount $PerWireFrequency:PerDay/Week/Month(circle)

Country(ies) of Origin:

Purpose:

OutgoingWires?Yes/No

IfYES,estimateamount $PerWireFrequency:PerDay/Week/Month(circle)

SendtoCountry(ies) :

Purpose:

PurchaseMonetaryInstrumentsYes/No

IfYES,estimateamount $

Purpose:

ACH DepositsYes/No

IfYES,expectedsourceofdeposits:

ACH DebitsYes/NoOnlineBankingYes/No

OtherBankServicesCustomer isInterestedIn:

(Loans,Cashier’s Checks, etc)

Willyouhaveyourpayroll/socialsecuritycominginautomaticallyintothisaccount?Yesor No

Nowtogetyouintherightownership,wewillneedtoknowhowyouplantoownthisaccount?

IndividualJointPODFiduciary

IfthisisaFiduciary,whattype?

Custodian

Powerof attorney

Representative PayerVAFiduciary

Name:

For Power ofAttorney, obtain POAform and information and identification for the attorney-in-fact