Fillable Certication Regarding Benecial Owners of Legal Entity Customers (Navy Federal Credit Union)

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Certication Regarding Benecial Owners of Legal Entity Customers (Navy Federal Credit Union)

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Navy Federal
®
Certication Regarding Benecial Owners of Legal Entity Customers
I. General Instructions
What is this form?
To help the government ght nancial crime, federal regulation requires certain nancial institutions to obtain, verify, and record information about the benecial
owners of legal entity customers. Legal entities can be abused to disguise involvement in terrorist nancing, money laundering, tax evasion, corruption, fraud,
and other nancial crimes. Requiring the disclosure of key individuals who own or control a legal entity (i.e., the benecial owners) helps law enforcement investigate
and prosecute these crimes.
Who has to complete this form?
This form must be completed by the person opening a new account on behalf of a legal entity with any of the following U.S. nancial institutions: (i) a bank or
credit union; (ii) a broker or dealer in securities; (iii) a mutual fund; (iv) a futures commission merchant; or (v) an introducing broker in commodities.
For the purposes of this form, a legal entity includes a corporation, limited liability company, or other entity that is created by a ling of a public document with
a Secretary of State or similar ofce, a general partnership, and any similar business entity formed in the United States or a foreign country. Legal entity does
not include sole proprietorships, unincorporated associations, or natural persons opening accounts on their own behalf.
What information do I have to provide?
This form requires you to provide the name, address, date of birth, and Social Security Number (or passport number or other similar information, in the case of
Non-U.S. Persons) for the following individuals (i.e., the benecial owners):
(i) Each individual, if any, who owns, directly or indirectly, 25 percent or more of the equity interests of the legal entity customer (e.g., each natural person
that owns 25 percent or more of the shares of a corporation); and
(ii) An individual with signicant responsibility for managing the legal entity customer (e.g., Chief Executive Ofcer, Chief Financial Ofcer, Chief Operating
Ofcer, Managing Member, General Partner, President, Vice President or Treasurer).
The number of individuals that satisfy this denition of “benecial owner” may vary. Under section (i), depending on the factual circumstances, up to four
individuals (but as few as zero) may need to be identied. Regardless of the number of individuals identied under section (i), you must provide the identifying
information of one individual under section (ii). It is possible that in some circumstances, the same individual might be identied under both sections (e.g., the
President of Acme, Inc. who also holds a 30% equity interest). Thus, a completed form will contain the identifying information of at least one individual (under
section (ii)), and up to ve individuals (i.e., one individual under section (ii) and four 25 percent equity holders under section (i)).
The nancial institution may also ask to see a copy of a driver’s license or other identifying document for each benecial owner listed on this form.
II. Certication of Benecial Owner(s)
Persons opening an account on behalf of a legal entity must provide the following information:
A.
Name and Title of Natural Person Opening Account
B.
Name, Type, and Address of Legal Entity for Which the Account Is Being Opened
C.
The following information for each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship, or otherwise,
owns 25 percent or more of the equity interests of the legal entity listed above. (If no individual meets this denition, please write “Not Applicable.”)
Name Address (Residential or Business Street Address)
Date of Birth (MM/DD/YY) Address Line 2
For U.S. Persons: Social Security Number Address Line 3
For Non-U.S. Persons: Social Security Number, Passport Number, and Country of
Issuance, or other similar identification number.*
City State
ZIP/Postal Code Country
*
In lieu of a passport number, Non-U.S. Persons may also provide a Social Security Number, an alien identication card number, or number and country of issuance of any other government-issued
document evidencing nationality or residence and bearing a photograph or similar safeguard.
Name Address (Residential or Business Street Address)
Date of Birth (MM/DD/YY) Address Line 2
For U.S. Persons: Social Security Number Address Line 3
For Non-U.S. Persons: Social Security Number, Passport Number, and Country of
Issuance, or other similar identification number.*
City State
ZIP/Postal Code Country
*
In lieu of a passport number, Non-U.S. Persons may also provide a Social Security Number, an alien identication card number, or number and country of issuance of any other government-issued
document evidencing nationality or residence and bearing a photograph or similar safeguard.
© 2018 Navy Federal NFCU 98 (4-18)
Page 1 of 2
*98*
For Office Use Only
Business Access No.
Clear
Name/Title Address (Residential or Business Street Address)
Date of Birth (MM/DD/YY) Address Line 2
Driver’s License or Government ID No. or State ID No.
ID No. State
For U.S. Persons: Social Security Number Address Line 3
For Non-U.S. Persons: Social Security Number, Passport Number, and Country of
Issuance, or other similar identification number.*
City State
ZIP/Postal Code Country
*
In lieu of a passport number, Non-U.S. Persons may also provide a Social Security Number, an alien identication card number, or number and country of issuance of any other government-issued
document evidencing nationality or residence and bearing a photograph or similar safeguard.
Name Address (Residential or Business Street Address)
Date of Birth (MM/DD/YY) Address Line 2
For U.S. Persons: Social Security Number Address Line 3
For Non-U.S. Persons: Social Security Number, Passport Number, and Country of
Issuance, or other similar identification number.*
City State
ZIP/Postal Code Country
*
In lieu of a passport number, Non-U.S. Persons may also provide a Social Security Number, an alien identication card number, or number and country of issuance of any other government-issued
document evidencing nationality or residence and bearing a photograph or similar safeguard.
Name Address (Residential or Business Street Address)
Date of Birth (MM/DD/YY) Address Line 2
For U.S. Persons: Social Security Number Address Line 3
For Non-U.S. Persons: Social Security Number, Passport Number, and Country of
Issuance, or other similar identification number.*
City State
ZIP/Postal Code Country
*
In lieu of a passport number, Non-U.S. Persons may also provide a Social Security Number, an alien identication card number, or number and country of issuance of any other government-issued
document evidencing nationality or residence and bearing a photograph or similar safeguard.
I, __________________________________________________________________________, hereby certify, to the best of my knowledge, that the information provided above is complete and correct.
(name of natural person opening account)
Signature Date (MM/DD/YY)
Legal Entity Identifier (optional)
D. The following information for one individual with signicant responsibility for managing the legal entity listed above, such as:
☐ an executive ofcer or senior manager (e.g., Chief Executive Ofcer, Chief Financial Ofcer, Chief Operating Ofcer, Managing Member, General
Partner, President, Vice President, Treasurer); or
☐ any other individual who regularly performs similar functions.
(If appropriate, an individual listed under section (C) above may also be listed in this section (D).)
© 2018 Navy Federal NFCU 98 (4-18)
Page 2 of 2
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Certication Regarding Benecial Owners of Legal Entity Customers (Navy Federal Credit Union)

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Completed 27 October 2020

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