Fillable Certification Regarding Beneficial Owners and Controlling Parties of (M&T Bank)

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Certification Regarding Beneficial Owners and Controlling Parties of (M&T Bank)

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In order to assist the government in fighting crimes that utilize the U.S. financial system, such as money laundering or terrorist financing,
federal regulations require financial institutions collect detailed information about the individuals who own and control legal entity
customers. This form must be completed by the person authorized to open an account or provide information on behalf of the legal
entity. Individuals named on this form may be asked to provide a physical form or photocopy of unexpired government identification.
An individual who is named as an Ultimate Beneficial Owner in Section B and also meets the definition of a Customer Level Controlling
Party need only be named in Section B with the notation that the individual meets both definitions. M&T may request additional and/or
updated information in the future, including more comprehensive ownership information.
DEFINITIONS
Certification Regarding Beneficial Owners and
Controlling Parties of Legal Entity Customers
What is the purpose of this form?
• Legal Entity Customer – Legal Entity Customers are defined as corporations, limited liability companies, all forms of partnerships,
entities created through the filing of a public document with the Secretary of State or similar office, and statutory trusts formed by filing
with the Secretary of State or similar office. Sole proprietors, trusts (other than statutory trusts), and unincorporated associations are
not required to complete this form.
• Ultimate Beneficial Owners – Ultimate Beneficial Owners (“UBOs”) are individuals that own or have interests in the entity. A UBO must be
an individual. For example, if the owners of Entity A are Entities B and C, the individuals who own Entities B and C would be the UBOs of
entity A.
• Customer Level Controlling Parties – Customer Level controlling parties are defined as individuals with authority over the financial
dealings of the entity. Examples include:
- President or CEO;
- Chairman of the Board of Directors;
- Chief Financial Officer;
- Managing Partners;
- Investment manager;
- Trustee and grantor for revocable trusts; and
- Trustee for irrevocable trusts.
An individual who holds a position as a controlling party of an entity solely due to his or her position as a U.S. federal, state or local elected
official need not be named.
• Acceptable forms of U.S. and Foreign Identification – If you are unable to provide one of these forms of identification, please speak to an
M&T employee to see if other accommodations can be made.
ADDRESS
The address provided for each individual named on this form must be a physical street address, and may be the entity customer’s physical
address. P.O. boxes are not acceptable for the purposes of this form.
Please be advised all information collected will only be used for the purpose of meeting regulatory requirements.
ACCEPTABLE FORMS OF I.D. FOR A NON-U.S. CITIZEN:
- Foreign Passport;
- Resident Alien Card;
- U.S. Department of State ID Card;
- U.S. Visa;
- Permanent Resident Card;
- National Identity Card issue by a Foreign Government; or
- Foreign Driver’s License.
ACCEPTABLE FORMS OF I.D. FOR A U.S. CITIZEN:
- U.S. passport or passport card;
- Driver’s License;
- Federal or State-issued photo I.D. Card; or
- U.S. Armed Forces Identification Card.
1
Due to M&T Bank and Wilmington Trust, N.A. existing as nancial institutions chartered under United States law, all subsidiaries of M&T Bank and Wilmington Trust, N.A. are required to adhere to United States regulations.
PAGE  OF 
SECTION A. CUSTOMER INFORMATION
SECTION B. ULTIMATE BENEFICIAL OWNERSHIP INFORMATION
Entity (Customer) Name:
Entity (Customer) Type (Partnership, Corporation, etc.):
Entity (Customer) Tax Identification Number:
Physical Address 1:
Address 2:
Address 3:
City: State: Zip: Country:
Full Name of Person Title of Person
Opening the Account: Opening the Account:
This section must be completed for each individual with at least a 25% ownership interest in the customer. See page 1 of this
document for a description of ultimate beneficial owners and acceptable forms of identification. If a legal entity customer is ultimately
owned by a trust, please complete this section for the trustee(s), leaving blank the percentage of ownership for each trustee listed.
If no individual meets the 25% ownership percentage requirement, please initial here:
Ultimate Beneficial Owner 1
Name: Date of Birth:
Address 1 (either Residential or Business):
Address 2:
Address 3:
City: State: Zip: Country:
Citizenship: Social Security Number (if U.S. Citizen):
Percentage of Ownership Interest (Leave Blank if Trustee):
Please check here if this individual is the trustee of a trust with at least a 25% ownership interest in the legal entity.
Name of the Trust: % of Ownership of Trust:
Please check here if this individual also meets the definition of a Customer Level Controlling Party.
For Bank Use Only
Identification Type Identification State (if U.S.)/
Presented: Number: Country of Issuance:
PAGE  OF 
Ultimate Beneficial Owner 2
Name: Date of Birth:
Address 1 (either Residential or Business):
Address 2:
Address 3:
City: State: Zip: Country:
Citizenship: Social Security Number (if U.S. Citizen):
Ultimate Beneficial Owner 3
Name: Date of Birth:
Address 1 (either Residential or Business):
Address 2:
Address 3:
City: State: Zip: Country:
Citizenship: Social Security Number (if U.S. Citizen):
Percentage of Ownership Interest (Leave Blank if Trustee):
Please check here if this individual is the trustee of a trust with at least a 25% ownership interest in the legal entity.
Name of the Trust: % of Ownership of Trust:
Please check here if this individual also meets the definition of a Customer Level Controlling Party.
Ultimate Beneficial Owner 4
Name: Date of Birth:
Address 1 (either Residential or Business):
Address 2:
Address 3:
City: State: Zip: Country:
Citizenship: Social Security Number (if U.S. Citizen):
Percentage of Ownership Interest (Leave Blank if Trustee):
Please check here if this individual is the trustee of a trust with at least a 25% ownership interest in the legal entity.
Name of the Trust: % of Ownership of Trust:
Please check here if this individual also meets the definition of a Customer Level Controlling Party.
PAGE  OF 
Percentage of Ownership Interest (Leave Blank if Trustee):
Please check here if this individual is the trustee of a trust with at least a 25% ownership interest in the legal entity.
Name of the Trust: % of Ownership of Trust:
Please check here if this individual also meets the definition of a Customer Level Controlling Party.
For Bank Use Only
Identification Type Identification State (if U.S.)/
Presented: Number: Country of Issuance:
For Bank Use Only
Identification Type Identification State (if U.S.)/
Presented: Number: Country of Issuance:
For Bank Use Only
Identification Type Identification State (if U.S.)/
Presented: Number: Country of Issuance:
SECTION C. CUSTOMER LEVEL CONTROLLING PARTY INFORMATION
Customer Level controlling parties are individuals with authority over the financial dealings of the entity. Each relevant customer
level controlling party of the entity must be listed in this section. See Page 1 of this document for a full definition of a customer level
controlling party under M&T Procedures and acceptable forms of identification. Additional spaces are available in the Addendum.
Customer Level Controlling Party 1
Name: Date of Birth:
Address 1 (either Residential or Business):
Address 2:
Address 3:
City: State: Zip: Country:
Citizenship: Social Security Number (if U.S. Citizen):
Role at Company:
Customer Level Controlling Party 2
Name: Date of Birth:
Address 1 (either Residential or Business):
Address 2:
Address 3:
City: State: Zip: Country:
Citizenship: Social Security Number (if U.S. Citizen):
Role at Company:
Customer Level Controlling Party 3
Name: Date of Birth:
Address 1 (either Residential or Business):
Address 2:
Address 3:
City: State: Zip: Country:
Citizenship: Social Security Number (if U.S. Citizen):
Role at Company:
PAGE  OF 
For Bank Use Only
Identification Type Identification State (if U.S.)/
Presented: Number: Country of Issuance:
For Bank Use Only
Identification Type Identification State (if U.S.)/
Presented: Number: Country of Issuance:
For Bank Use Only
Identification Type Identification State (if U.S.)/
Presented: Number: Country of Issuance:
Customer Level Controlling Party 4
Name: Date of Birth:
Address 1 (either Residential or Business):
Address 2:
Address 3:
City: State: Zip: Country:
Citizenship: Social Security Number (if U.S. Citizen):
Role at Company:
SECTION D. CERTIFICATION
I, (name of natural person opening the account or providing the above
information), hereby certify, to the best of my knowledge, that the information provided above is complete and correct.
SIGNATURE: DATE:
PAGE  OF 
Equal Housing Lender. ©2017 M&T Bank. Member FDIC. CS16507 C (11/17) mtb.com
For Bank Use Only
Identification Type Identification State (if U.S.)/
Presented: Number: Country of Issuance:
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Certification Regarding Beneficial Owners and Controlling Parties of (M&T Bank)

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Completed 6 August 2021

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