Demographic Form for Bank--Kamya Jones

Tallahassee Community College **We aren't endorsed by this school
Oct 29, 2023
Uploaded by MateAlligatorPerson951 on
Personal Demographic Information Name: Home Address: E Mail Address: Home Phone #: Business Phone #: Cell Phone #: US Citizen Yes or No Social Security # (if applicable): Date of Birth: Mother's Maiden Name: Employer: Occupation: Signer Title/Capacity: Are you currently or have you ever been a senior political, governmental, or military official with a Non-US country?" Yes No Does any member of your immediate family or anyone closely associated with you hold such a position?" Yes No If you answer yes, provide the relationship to the signer, what the position was and for what country Two Copies of Identification to be Provided (Please list copies that will be sent) I certify under penalty of perjury that the social security or Employer ID number shown on this form is my correct taxpayer ID number and that I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding (Notice: if you are subject to backup withholding, cross out these lines) and I am a U.S. Citizen or other U.S. person. The undersigned acknowledges by requesting to be a signer on a bank account with City National Bank of Florida (CNB), CNB is hereby authorized to make inquiries from any consumer reporting agency, including but not limited to a check protection server, in connection herewith. This authorization is given pursuant to the Fair Credit Reporting Act. ___________________________________ Signature Date
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Uploaded by MateAlligatorPerson951 on