Patriots Act Form PDF Details

The Patriots Act Form is a necessity for all businesses and organizations in order to properly document the details of any emergency or crisis. The form can be customized to fit the specific needs of your company, and should be updated regularly with any new information or changes. Having a well-organized Patriots Act Form will help ensure that your business is able to react swiftly and effectively in the event of an emergency.

Here is some data that might be useful if you're looking to learn just how long it will require you to fill out patriots act form and what number of PDF pages it contains.

Form NamePatriots Act Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namespatriots disclosure form, patriot act disclosure form, patriots disclosure identification form, patriot act form

Form Preview Example

Patriots Act Disclosure

Borrower Identification

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account.

Please provide the following information. We required two forms of identification for each borrower to comply with Section 326 of the Act.

Borrower’s Name



Loan Number








Date of Birth





City, State Zip



Social Security #/Tax ID #


IMPORTANT - Information listed below must be exactly as indicated on the document.

Primary Forms of Identification - must display Borrower’s name



Country/State of

ID Number

Date of Birth

Expiration Date










State Issued Driver License








State Issued ID Card








Military ID Card
















US Alien Registration Card








Canadian Driver License








Secondary Forms of Identification-must display Borrower’s name






Name of Issuer on

ID Number

Issuance Date

Expiration Date











Social Security Card

U.S. Govt.






Government Issued Visa








Birth Certificate








Non-US/Canadian Driver License








Most Recent Signed Tax Returns








Property Tax Bill








Voter Registration Card








Organizational Membership Card








Bank/Investment/Loan Statements








Paycheck stub with name








Most Recent W-2








Home/car/renter insurance papers








Recent utility bill































I certify that I have personally viewed and accurately recorded the information from the documents identified above, and have reasonably confirmed the identity of the applicant.







Printed Name



*For persons without a SSN/TIN, the ID number must be from one of the following: passport, alien ID card, or any other government issued document evidencing nationality or residence and bearing a photograph or similar safeguard.

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