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Accounts offered by American Express National Bank.
Affidavit of Identity
STATE OF
COUNTY OF
The undersigned affiant, on this day personally appeared before me, and having presented a valid picture I.D. in the form
of a
, who after being duly sworn, on penalty of perjury, deposes
Driver’s License, State Identification, Passport, Military Identification
and says:
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:
City
State
Zip Code
Social Security Number of Affiant:
Signature of Affiant:
Subscribed and sworn to before me, this
day of
(day of the month)
(Seal)
, 20
(month)
.
(year)
Signature of Notary:
Full Name of Notary:
My commission expires:
PLEASE SUBMIT REQUEST VIA FAX OR MAIL TO ONE OF THE FOLLOWING
Fax: 1-800-542-0779
Mail: American Express National Bank,