PeoplesUnitedBank, N.A. – OffSiteRetailSignatureCard–Completeall applicablefields for the product(s) you are opening
PRODUCTACCOUNT #
PRODUCTACCOUNT #PRODUCTACCOUNT # / Checks?:yes______no______
GraduationDate(ofPrimaryOwner):
CollegeAffiliation(ofPrimaryOwner):
AccountTitle: Enterthenameandinformationforallcustomersthatwillbelinkedtotheaccount,
Primary Owner:Relationshipto Account:Gender:New Cust ?YES/ NO EIN/SSN (CertifyBelow) Email: Phone:
Addt’lAddress:DOB:Cell:

Street:Occupation:

City/St/Zip:Prim ID Type /# /Exp: / M/ F
SecIDType/Exp(ifapplicable):
Owner(2):Relationshipto Account:Gender:New Cust ?YES/ NO EIN/SSN: Email: Phone:
Addt’lAddress:DOB:Cell:

Street:Occupation:

City/St/Zip:Prim ID Type /# /Exp: / M/ F
SecIDType/Exp(ifapplicable):
Owner(3):Relationshipto Account:Gender:New Cust ?YES/ NO EIN/SSN: Email: Phone:
Addt’lAddress:DOB:Cell:

Street:Occupation:

City/St/Zip:Prim ID Type /# /Exp: / M/ F
SecIDType/Exp(ifapplicable):
I/WehavereceivedacopyoftheConsumerDepositAccountAgreement,FundsAvailabilityPolicyandElectronicFundTransfersDisclosureStatementandAgreement,andtheScheduleofDepositAccountCharges/ScheduleofInterestandagreetotheirtermsandconditionsasamendedfromtimetotime.I/WeandPeople’sUnitedBank,N.A.agreetowaiveourrightstoatrialbyjuryinanylegalaction,proceeding,orcounterclaimarisingoutoforinconnectionwiththeAccount.ByselectingtheM$/ATMcheckboxbelow,youauthorizePeople’s UnitedtoorderanATMCardand/orMasterMoneyDebitCard
onyourbehalfforoneormoreoftheaccountslistedabove.CertificateofDepositaccountsarenoteligibleforanATMorMasterMoneycard.AdditionalATMand/orMastermoneyDebitCardeligibilityrulesmay
Signature 1
Signature 2 / X / M$/ATM Signature3M$/ATM
M$/ATM
NameLine 1
AccountName Line 2
MailingName/AddressAddress:
Street
City/State/Zip / CERTIFICATIONOFTAXPAYERIDENTIFICATIONNUMBER
Underpenaltiesofperjury,Icertifythat(1)theTINnumbershownonthisformismycorrecttaxpayeridentificationnumber,and(2)(a)Iamnotsubjecttobackupwithholdingforthereasoncheckedbelow,or
(b)IhavenotbeennotifiedbytheInternalRevenueService(IRS)thatIamsubjecttobackupwithholdingasaresultofafailuretoreportallinterestanddividends,or(c)theIRShasnotifiedmethatIamno
longersubjecttobackupwithholding,and(3)UnlesstheNon–ResidentAlienboxbelowischecked,IcertifythatIamaU.S.person,includingaU.S.ResidentAlien,and(4)TheFATCAcode(s)enteredonthisform(ifany)indicatingthatIamexemptfromFATCAreportingiscorrect.Ifyouaresubjecttobackupwithholdingyoumuststrikeouttextfollowing#2.
FATCA Code
(FormW-9isrequired)□ (FormW-8isrequired)
Signature :Date:
The followingexceptioncondition existson thisaccount:
ManagementApproval:
CHEXsystems called

CS3v92/2015Branch

Employee#OpenDate

KnowYourCustomerQuestions

Useone Know YourCustomer Questionsheetfor each account owner.Destroythis questionsheet once the customerprofile has been uploaded.

CustomerName:

Doesthecustomerhaveanyaccountswiththefollowingrelationships?NoYes

Individual, Joint, Joint with Rights of Survivorship, Joint and Several, Individual in Trust For, Joint in Trust For, Doing Business As, Primary Owner,HSA Owner,MasterPrimary

Note: Answeryes if the customer currently has accounts withany ofthe relationships orthe account they areopening today will have anyof the above relationships.

IsthecustomeraU.S.Resident?NoYes

Note: If you answer Yes to this question, BankerInsight will automaticallypre-fill the country ofcitizenship toUnited Statesof America.

Whatisthecustomer’scountryofcitizenship?

CountryNote: Ifthe customer is aU.S. Resident but a citizenof anothercountry, the dropdown box canbe changed.

Doesthecustomerhavedualcitizenship?NoSelectionYes,

Country

Areyouoranyofyourimmediatefamilymemberscurrentorformerseniorofficialsofaforeigngovernmentorpoliticalparty?NoYes

IfYestothequestionabove,whatisthecustomer’sPEPRelationship:

Current orformerofficialofaforeign government

Senior official of a major foreign political party

Immediatefamily member of official orpolitician

Senior executive foreignstate ownedbusiness

Employer_

AnticipatedMonthlyActivity:

GenderFemaleMale

Cash Deposits$0-$2,500$2,501-$5,001$5,001-$10,000$10,001-$20,000

$20,001-$50,000$50,001-$100,000$100,001-$250,000Over $250,000

Cash Withdrawals$0-$2,500$2,501-$5,001$5,001-$10,000$10,001-$20,000

$20,001-$50,000$50,001-$100,000$100,001-$250,000Over $250,000

AnticipatedMonthlyWireTransferActivity:

Domestic Incoming$0-$2,500$2,501-$5,001$5,001-$10,000$10,001-$20,000

$20,001-$50,000$50,001-$100,000$100,001-$250,000Over $250,000

DomesticOutgoing$0-$2,500$2,501-$5,001$5,001-$10,000$10,001-$20,000

$20,001-$50,000$50,001-$100,000$100,001-$250,000 Over $250,000

Foreign Incoming$0-$2,500$2,501-$5,001$5,001-$10,000$10,001-$20,000

$20,001-$50,000$50,001-$100,000$100,001-$250,000 Over $250,000

Originating Country(ies) of incomingwires:

Foreign Outgoing$0-$2,500$2,501-$5,001$5,001-$10,000$10,001-$20,000

$20,001-$50,000$50,001-$100,000$100,001-$250,000 Over $250,000

Originating Country(ies) of incoming wires: