Accounts offered by American Express National Bank.
Affidavit of Identity
The undersigned affiant, on this day personally appeared before me, and having presented a valid picture I.D. in the form
, who after being duly sworn, on penalty of perjury, deposes
Driver’s License, State Identification, Passport, Military Identification
My name is
, and I am the person identified in the picture I.D.
presented to the undersigned authority. I make this affidavit in connection with a bank account held in the name of with
American Express National Bank.
Full Name of Affiant:
Address of Affiant:
Social Security Number of Affiant:
Signature of Affiant:
Subscribed and sworn to before me, this
(day of the month)
Signature of Notary:
Full Name of Notary:
My commission expires:
PLEASE SUBMIT REQUEST VIA FAX OR MAIL TO ONE OF THE FOLLOWING
Mail: American Express National Bank,