Fillable B2B Bank Client Identification Form (B2B Bank)

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B2B Bank Client Identification Form (B2B Bank)

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603-03-063E (03/14/2018)
Under the Proceeds of Crime (Money Laundering) and Terrorist Financing Regulation
1. Client Information and Identification ( Do not photocopy the pieces of ID)
B2B Bank Client Identification Form
Page 1 of 3
Country of residence
Identity Verification
Branch No.
Loan No. Suff.
Total number of borrowers:
• Driver’sLicenceissuedinCanada
• PassportissuedbyCanadianorForeignGovernment
• CerticateofIndianStatus-issuedbytheGovernmentofCanada
• CanadianPermanentResidenceCard
• QuebecHealthCard(withphotoIDandexpirydate)
• IdenticationCard-issuedbyProvince(notavailableinQuebec)
• CitizenshipCard-issuedpriortoFebruary2012
[NOTE: Health Cards in Quebec must be offered by clients - they cannot be
requested.]
• CerticateofCanadianCitizenshiporNaturalization
• ProvincialHealthCard(thathasnophotoand/orexpirationdate)
• BirthCerticate-issuedinCanadaonly(bytheGovernment,Churchissue
notaccepted)
• SocialInsuranceCard-issuedbytheGovernmentofCanada
• OldAgeSecurityCardissuedpriorto2008(containstheSINoftheindividual)
• MajorCreditCard(bearingthenameoftheindividualandtheindividual’ssignature)
• College/UniversityStudentIDCard(bearingtheindividual’sname,signatureand
photograph)
• FirearmsLicence-issuedfederallywithphotoID
• NEXUSCard(bearingtheindividual’sname,photographandpassportnumber)
• CNIBCard
• CanadianForcesIdentificationCard(bearingthenameoftheindividual,
photographandexpirydate)
[NOTE: Health Cards are not acceptable identication for Manitoba, Ontario,
Prince Edward Island or Nova Scotia.]
Detailsoftwopiecesofvalididenticationarerequired.
Theclient(s)mustclearlyindicatetheFullnameasprovidedontheID,IDtype,IDnumber,IDPlaceofissue(jurisdiction),Issuingauthority,Issuingcountry,ID
Vericationdate,Dateofissueofthedocument(ifapplicable)andtheIDExpirydate.
Type 1 Documentation
Detailsofthefollowingarerequired:
• OnepieceofType1DocumentationandonepieceofType2Documentation
OR
• TwopiecesofType1Documentation
Type 2 Documentation
Borrowers Last Name
BorrowersFirstName
Citizenship
1.FullnameasitappearsonID
Issuingauthority Dateofissue(ifapplicable)(mm/dd/yyyy)
IDType
IDnumber
IDExpirydate(mm/dd/yyyy)
IDPlaceofissue(jurisdiction)
IssuingCountry IDVerificationdate(mm/dd/yyyy)
2.FullnameasitappearsonID
Issuingauthority
Dateofissue(ifapplicable)(mm/dd/yyyy)
IDType
IDnumber
IDExpirydate(mm/dd/yyyy)
IDPlaceofissue(jurisdiction)
IssuingCountry IDVerificationdate(mm/dd/yyyy)
Dateofbirth(mm/dd/yyyy)
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603-03-063E (03/14/2018)
Page 2 of 3
Co-borrowers Last Name
Co-borrowersFirstName
1.FullnameasitappearsonID
Issuingauthority Dateofissue(ifapplicable)(mm/dd/yyyy)
IDType
IDnumber
IDExpirydate(mm/dd/yyyy)
IDPlaceofissue(jurisdiction)
IssuingCountry IDVerificationdate(mm/dd/yyyy)
2.FullnameasitappearsonID
Issuingauthority
Dateofissue(ifapplicable)(mm/dd/yyyy)
IDType
IDnumber
IDExpirydate(mm/dd/yyyy)
IDPlaceofissue(jurisdiction)
IssuingCountry IDVerificationdate(mm/dd/yyyy)
B2B Bank Client Identification Form
Under the Proceeds of Crime (Money Laundering) and Terrorist Financing Regulation
Co-borrowers Last Name
Co-borrowersFirstName
1.FullnameasitappearsonID
Issuingauthority Dateofissue(ifapplicable)(mm/dd/yyyy)
IDType
IDnumber
IDExpirydate(mm/dd/yyyy)
IDPlaceofissue(jurisdiction)
IssuingCountry IDVerificationdate(mm/dd/yyyy)
2.FullnameasitappearsonID
Issuingauthority
Dateofissue(ifapplicable)(mm/dd/yyyy)
IDType
IDnumber
IDExpirydate(mm/dd/yyyy)
IDPlaceofissue(jurisdiction)
IssuingCountry IDVerificationdate(mm/dd/yyyy)
Country of residence
Citizenship
Dateofbirth(mm/dd/yyyy)
Country of residence
Citizenship
Dateofbirth(mm/dd/yyyy)
Identity Verification
Identity Verification
Co-borrowers Last Name
Co-borrowersFirstName
1.FullnameasitappearsonID
Issuingauthority Dateofissue(ifapplicable)(mm/dd/yyyy)
IDType
IDnumber
IDExpirydate(mm/dd/yyyy)
IDPlaceofissue(jurisdiction)
IssuingCountry IDVerificationdate(mm/dd/yyyy)
2.FullnameasitappearsonID
Issuingauthority
Dateofissue(ifapplicable)(mm/dd/yyyy)
IDType
IDnumber
IDExpirydate(mm/dd/yyyy)
IDPlaceofissue(jurisdiction)
IssuingCountry IDVerificationdate(mm/dd/yyyy)
Country of residence
Citizenship
Dateofbirth(mm/dd/yyyy)
Identity Verification
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603-03-063E (03/14/2018)
Page 3 of 3
Certicateplaceofissue(Province/Territory,State/Country)
IncorporationCerticatenumber
In addition, obtain the following information if the third party is a legal person:
Iherebyconrmhavingpersonallyascertainedtheidentityoftheclient(s)forloanandguaranteegrantingpurposesonthedateshownbelow.Ialsodeclare
thathavingaskedtheclient(s)thequestionpertainingtothirdpartydeterminationandhavingcompletedtheabovesection3wheneverIhadreasonable
causetosuspectthattheloan(s)couldbeusedbyathirdpartyoronbehalfofathirdparty.
Ialsoconrmthattheinformationprovidedinthisreport,suchasthenames,datesofbirthandidenticationdetails,correspondsineveryrespecttothe
informationprovidedonthepiecesoforiginalIDthatwerepresented.
Signed on (mm/dd/yyyy)
NameofLawyerorLender’sRepresentative
Signature
X
Thirdpartyname(IndividualorCompany)
Thirdpartydateofbirth(mm/dd/yyyy)(Individual)
Thirdpartycitizenship
Province Postal code
Thirdpartyfulladdress(street#andname,apt.#)(notonlyaP.O.Boxnumber)
City
ThirdpartyCountryofresidence
Thirdpartyresidencetelephonenumber
Thirdpartybusinesstelephonenumber
Thirdpartycelltelephonenumber
Province Postal code
Thirdpartyemployeraddress
Yearswithemployer
Thirdpartydetailedoccupation(examples:actor,cook)
Thirdpartyemployertelephonenumber
Thirdpartystatus(examples:employed,unemployed,retired,student)
ThirdpartyIndustry/Typeofbusiness(examples:entertainment,foodservice)
Thirdpartyemployername
City
Relationshipbetweenclientandthirdparty
B2B Bank Client Identification Form
Under the Proceeds of Crime (Money Laundering) and Terrorist Financing Regulation
Is(are)theloan(s)tobeused,inwholeorinpart,byapersonotherthantheclientorbytheclientonbehalfofanotherperson?
No
Yes (If so, complete the “Third Party Identication” section.)
4. Comments
5. Signature of Lawyer or Lender’s Representative
3. Third Party Identification
2. Third Party Determination Requirement
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B2B Bank Client Identification Form (B2B Bank)

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Completed 21 December 2020

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