Checkone)(Checkone

LEGALENTITYPROFILE

(Checkone)(Checkone)

NewCustomer

Existing Customer

Exempt

InPerson

Other

NameofLegalEntity:

PhysicalAddress:

MailingAddress:

Phone number:

EmailAddress:

Website:

Signer Name:

CIFNumber:

IsanyAuthorizedSigneraPoliticallyExposedPerson(PEP)?YesorNo

If“Yes,”Signer’s Name:

CountryAffiliation:

and

Position:

TypeofLegalEntityCorpLLCPartnershipSoleProprietorshipNon-profitAgentTrust Estate Other

NAICS:

Whatdoes thebusiness do?

Pleasecheck and specifytype ofbusiness:

DomesticForeign–Name ofCountry:

ForeignRegistrationID:

Retail:

Wholesale:

Manufacturing:

ServiceProvider:

Import/ExportTo/FromCountry(ies):

Whatis theExpectedAnnualRevenue?

Name of MajorSuppliers/Vendors:

Name of Major Customers:

Where is customercurrently banking?

Whatcounties/parishes does the business operate in?

Whatstatesdoesthebusinessoperatein?

Where are yourcustomers located?

Whatis thepurpose of theaccount (Operations,Payroll,etc)?

Which bankis themoneycomingfrom?

OtherBankServicesCustomer is Interestedin:

(ArmoredService,Loans, Letters ofCredit, Cashier’s Checks, etc.)

#Deposits /Month(Est)

$Deposits /Month(Est) DepositCash?Yes/No

#Checks Withdrawals/Month(Est)

$Checks Withdrawals/Month(Est)

IfYES,estimateamount $WithdrawCash?Yes/No

IfYES,estimateamount $

PerMonth/PerTransaction

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

If YES, estimate amount $ Purpose: Purpose:

ACH DepositsYes/No

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

IfYES,expectedsourceofdeposits: ACH Debits Yes / No

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

Payees:OnlineBanking Yes/ No

Isthecustomeraprofessional service provider? / Yes / or / No
Isthisaccount an IOLTAaccount? / Yes / or / No

Internetgambling questions

Does your company have any games or financial activities on its website? / Yes / or / No
Do you provide servicestocompanies whoprovideinternetgambling? / Yes / or / No

Iflegalinyourstate,providelicensing.Otherwisehavecompanysigncertificationthatitisnotengagedinunlawfulinternetgambling.

MSBQuestions

Doesyourcompanycashchecksover$1000? / Yes / or / No
Doesyourcompanyissuecashier’schecksormoneyordersover$1000? / Yes / or / No
Doesyourcompanyexchangecurrencyover$1000? / Yes / or / No
Doyoutransmitcurrencyevenvirtualcurrencyatanydollaramount? / Yes / or / No
Doyouprovideprepaidcards? / Yes / or / No

IfsoyoumustregisterasanMSBwithfincen.gov

Excludes:HSA,HRAs,FSAs,closedloopunder$2000,cardsthatareover$1000butarenotreloadable,cardsthatdonotallowinternationaltransactions

Doyousellprepaidcards?YesorNo

Ifso,provide:•CopyofAMLPolicy•CopyofRegistrationwithFinCEN•PreviousBankStatements.

PrivatelyHeldATMs(CompletewhencustomerhasanATMonpremisenotownedbyabank)DoesthebusinesshaveanyprivateATMmachineslocatedonthepremises? Yes or NoIfso,doesyourbusinessownorleasefromanothercontractor?Wewillneed:

•CopyoftheATMagreementwithsponsoringentity

•Exactphysicallocation(s)oftheATM(s)

•Copyofstateregistration(ifrequiredbystate)

•CopyofthreemonthsATMactivitystatements

•Descriptionofcurrencyservicingarrangementsincludinghowiscashbeingreplenished(storeproceeds,armoredcar,etc)

Casino(CompleteforCasinosandCardClubs)

Isthecustomeracasino?YesorNo

Ifso,pleaseprovide:•CopyofAMLPolicy•CopyofAudit•PreviousBankStatements.

Nongovernment Organizations(Charities,nonprofit,clubs,civicorganizations,campaigns)

Whatisthepurposeofyournonprofitorganization?

Wheredothedonationscomefrom?

Howisyourorganizationstructured?

Note:somearerequiredtoregisteratsecretaryofstateifsoacopyofthestateregistration

MedicalMarijuanaRelated Questions

Isthisbusinessamarijuana-relatedbusiness?YesorNoTypeofBusiness

(ExampleInsurancecompany,landlord,securitysystemsetc.)

ApproximateAnnualRevenue Whatpercentageofyourbusinessisdirectlytiedtomarijuanabusiness? %

Whatprocessdoyouhaveinplacetomakesurethemarijuanabusinessislicensed?

ThirdPartyPaymentProcessors

Doyouprocesspaymentsforanotherpersonorentity?Yes or No

•Ifyoudo,wewillneedalistofyourmerchants.

•Wewillneedalltheanticipatedvolumeandtypesoftransactionsthatyouwillengagein.

•Wewillneed3monthsofyourpreviousbankstatements.

Doesyourthirdpartypaymentprocessorleasespacetootherprocessors?Yes or No

What is the volume? Whattypes of transactions areprocessed? Whoare your clients? Howdoyouscreenanewmerchant?

ThirdPartyPaymentProcessors(cont)

Whattypesofinstrumentsareusedforpayments?

ACH

Remotelycreatedchecks

Other:

Whatgeographicregionsdoyoucover?

Instate

Incounty

IntheUS

International

How many merchantsdo you process for? Doyou rent space on your server to otherpaymentprocessors? Doyou keep returns in a separate account? Whatpercentageofreturnsdoyouhave?

Customerwillprovidedomesticdocumentsforbusinesswhichbeganinthisstate.Foreigndocumentationiffromanotherstate.CustomerswhomeetCIPdocumentationexemptionarenotedonexemptionlist.Obtainfictitiousnamewhenapplicable.WemayrequireIDonallsigners.

Documentary verification:

•SoleProprietorship:Governmentissueddocument,ifrequired

•GeneralPartnership:Partnershipagreement(ifany),Governmentissueddocument.

•LimitedLiabilityPartnership:PartnershipRegistration,PartnershipAgreement.

•LimitedPartnership:Governmentissueddocument,PartnershipAgreement.

•LimitedLiabilityCompany:Governmentissueddocument,OperatingAgreement.

•Corporation:Governmentissueddocument,Minutes.

Nondocumentary verification:

•ThirdPartyVerification

•SecretaryofState

•LetterofWelcome

Anydiscrepancyindocumentationandsecretaryofstate?YesorNoHowisitbeingresolved?

*Seeexemptionsfordocumentationonbusinessandexemptionsfordocumentationonowners.

Personsopeninganaccountonbehalfofalegalentitymustprovidethefollowinginformation:

a.NameTitleofPersonOpeningAccount:

b.NameTypeofLegalEntityforWhichtheAccountisBeingOpened:

c.Personopeningaccountonbehalfofalegalentitymustprovidethefollowinginformationunlessthisisanexistingaccountorarenewalandtheinformationpreviouslyobtainedisstillcorrect.Intheevent ofanexistingcustomer,havethepersonopeningtheaccountjustsignthelastpageinPart6.

1.

Name

DateofBirth

CopyofIDobtained

Address(ResidentialorBusinessStreetAddress)

*SocialSecurityNumber

2.

Name

DateofBirth

CopyofIDobtained

Address(ResidentialorBusinessStreetAddress)

*SocialSecurityNumber

3.

Name

DateofBirth

CopyofIDobtained

Address(ResidentialorBusinessStreetAddress)

*SocialSecurityNumber

4.

Name

DateofBirth

CopyofIDobtained

Address(ResidentialorBusinessStreetAddress)

*SocialSecurityNumber

(Ifnoindividualmeetsthisdefinition,pleasewrite“NotApplicable.”) (NonprofitCorporationsdonothave25%ownersection,onlyPartd.)

*IfNonUSPersonuseSSN,PassportNumberorsimilarnumber.

d.Thefollowinginformationforoneindividualwithsignificantresponsibilityformanagingthelegalentitylistedabove,suchas:

•Anexecutiveofficerorseniormanager(e.g.,ChiefExecutiveOfficer,ChiefFinancialOfficer,ChiefOperatingOfficer,ManagingMember,GeneralPartner,President,VicePresident,Treasurer);or

•Anyotherindividualwhoregularlyperformssimilarfunctions.

Ifappropriate,anindividuallistedundersection(c)abovemayalsobelistedinthissection(d).

Name

Address(ResidentialorBusinessStreetAddress)

DateofBirth

*SocialSecurityNumber

CopyofIDobtained

*IfNonUSPersonuseSSN,PassportNumberorsimilarnumber.

Exemptionsfordocumentation.

Exempt from both CIPand beneficial ownership.

•Afinancial institution regulated by a Federal functional regulator or a bank regulated by a State bank regulator;

•Exemptperson. For purposesof thissection, anexemptpersonis:

(1)Abank, totheextentof suchbank’s domesticoperations;

(2)Adepartment oragency of theUnited States, of anyState, or of any political subdivision of any State;

(3)Anyentityestablishedunder the laws of the UnitedStates,of anyState, orof anypolitical subdivisionof anyState, or underan interstate compactbetween two ormoreStates,thatexercises governmentalauthority onbehalfof theUnited States or any suchState or politicalsubdivision;

(4)Anyentity, other thana bank, whose commonstockoranalogousequityinterestsarelistedon the NewYorkStockExchangeor theAmericanStockExchangeor whose commonstock oranalogous equity interestshavebeendesignatedas a NASDAQNational MarketSecuritylisted on theNASDAQ Stock Market(exceptstock or interestslisted under theseparate ‘‘NASDAQCapital MarketsCompanies’’heading),provided that,forpurposes of this paragraph (b)(4),aperson thatis a financial institution, other than a bank, is an exempt person only to the extent of its domestic operations;

Other exemptions for beneficial owners.

•(5)Anysubsidiary,other thanabank,ofanyentitydescribedin paragraph (b)(4)of thissection(a ‘‘listedentity’’)that isorganizedunder thelaws of theUnited States orof any Stateand at least 51percent of whose commonstock or analogousequity interest isowned by the listed entity,provided that,forpurposes of this paragraph (b)(5), a person that is a financial institution, other thana bank,isanexempt persononly totheextent of its domestic operations;

•Anissuerof aclass of securitiesregistered under section 12of theSecuritiesExchangeAct of 1934 or thatis requiredtofile reports under section 15(d) of thatAct;

•An investment company, as defined in section 3 of theInvestmentCompanyAct of 1940, thatis registeredwith theSecurities and Exchange Commission under thatAct;

•An investment adviser, as defined in section 202(a)(11) of theInvestmentAdvisersAct of1940, thatis registeredwith theSecurities and Exchange Commission under thatAct;

•An exchange or clearing agency, as defined in section 3 oftheSecuritiesExchangeAct of1934, thatis registeredundersection 6 or 17Aof thatAct;

•Any otherentity registered with theSecurities and ExchangeCommission under the Securities ExchangeAct of 1934;

•Aregisteredentity,commodity pooloperator,commoditytrading advisor, retailforeign exchange dealer, swapdealer,or major swap participant, each as defined in section 1a of theCommodity ExchangeAct, thatis registeredwith theCommodity FuturesTrading Commission;

•Apublic accounting firm registered under section 102 of the Sarbanes–OxleyAct;

•Abank holding company, as defined in section 2 of the Bank

HoldingCompanyAct of1956 (12U.S.C. 1841) or savingsand loan holding company, as defined in section 10(n) of theHome Owners’LoanAct (12 U.S.C 1467a(n));

•Apooledinvestment vehiclethatisoperated oradvised by a financial institution excluded under paragraph (e)(2) of this section;

•An insurance company that is regulated by a State;

•Afinancial market utility designated by the Financial Stability OversightCouncil underTitleVIII of theDodd-FrankWallStreet Reform and Consumer ProtectionAct of 2010;

•Aforeign financial institution established in a jurisdiction where the regulator of such institution maintains beneficial ownership information regarding such institution;

•Anon-U.S.governmentaldepartment,agencyor politicalsubdivisionthat engages onlyin governmental ratherthancommercial activities; and

•Anylegalentity only tothe extent thatitopens a privatebanking account subjectto §1010.620 of this chapter.

The Legal entity customers are subject only to the control.

•Apooledinvestment vehiclethatisoperated oradvised by a financial institution not excluded under paragraph (e)(2) of this section; and

•Any legal entity that is established as a nonprofit corporation or similar entity and has filed its organizational documents with theappropriate State authorityas necessary.

Activity Exemptions as long as no payments to or receivefromthirdparties.

•Atthe point-of-sale to provide credit products, includingcommercialprivatelabel creditcards,solelyforthepurchaseof retail goods and/or servicesat theseretailers,up toa limitof $50,000;

•To finance the purchase of postage and for which payments are remitted directly by the financial institution to the provider of the postage products;

•To finance insurance premiums and for which payments are remitted directly by the financial institution to the insurance provider or broker;

•To finance the purchase or leasing of equipment and

for which payments are remitted directly by the financial institution tothevendor orlessor of this equipment.

ExistingCustomersarenotexemptfrombeneficial ownership if the entity is adding a new account