Agent Examination of Identification Form

Identification Verification Form
CLIENT NAME: ___________________________________________
I, ____________________________, attest that (i) I understand and accept that I am acting as an agent on behalf of the mortgagee for
the purpose of ascertaining the identity of the Borrower, Guarantor and/or Signing Officer listed below; (ii) I am currently in good
standing and entitled to practice law without any restrictions(iii) I have personally met with each individual; (iv) I have examined two
valid and current original identification documents from the lists in Appendix A as recorded below, one of which includes a
photograph of the individual and was issued by a federal, territorial or provincial government, and have been verified by me in
accordance with the Proceeds of Crime (Money Laundering) and Terrorist Financing Regulations of Canada and (v) I attach a
photocopy of both sides of each ID hereto.
Last Name
First Name
Middle Name
Address
(e.g.: May 14, 1975)
Occupation1
(include title and industry)
City
Country
Date of Birth
ID Type
ID Number
Country & Province/State of Issuance
ID Type
ID Number
Country & Province/State of Issuance
(e.g., Ontario, Canada)
(e.g., Ontario, Canada)
THIRD PARTY CERTIFICATION FOR BORROWER ONLY: (not required for guarantor) (check appropriate box)
I hereby certify that I/Corporation will be the (or one of the) registered owner(s) of the property on closing and:
the property will not be used by, or on behalf of,
or is for the benefit of, a third party.
OR
the property will be used by, or on behalf of,
or is for the benefit of, a third party.2
POLITICALLY EXPOSED PERSON (PEP) OFFICIAL CERTIFICATION: (check appropriate box)
I hereby certify that I or members of my family are:
NOT a Politically Exposed Person
as defined in Appendix “A”.
OR
a Politically Exposed Person,
as defined in Appendix “A”.
CLIENT SIGNATURE:
1
Vague description such as “Business-for-Self”, “self-employed”, “consultant”, “investor”, “business owner”, “businessman”,
“entrepreneur” or “Signing Officer” is not acceptable. The occupation must clearly reflect the nature of the work and the industry in
which it is performed.
2
If you check this box you must also complete the attached Appendix “B” Third Party Information Form.
Signature of Solicitor (acting as an agent):
Name (please print):
________________________
__________________________________________
Date: _______________________
*Please be sure client signs the PEP & 3rd Party Declaration, above*
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APPENDIX A – List of Acceptable Identification Documents
Obtain two pieces of identification, at least one of which contains a photograph and is from List A.
List A:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Driver’s Licence
Passport
Canadian Citizenship Card or Certificate
Permanent Resident Card
Firearms Acquisition Certificate (FAC) or a licence — either a Possession Only or a Possession and Acquisition Licence
(PAL) — issued by the Canadian Federal government under the Firearms Act.
Armed Forces ID issued by the Government of Canada
FAST Express Card/NEXUS Card
Provincial or territorial identification card issued by any of the following:











the Ministry of Transportation of Ontario (Ontario Photo Card)
the Insurance Corporation of British Columbia;
Alberta Registries;
Saskatchewan Government Insurance;
Manitoba Public Insurance
the Department of Service Nova Scotia and Municipal Relations;
the Department of Transportation and Public Works of the Province of Prince Edward Island;
Service New Brunswick;
the Department of Government Services and Lands of the Province of Newfoundland and Labrador;
the Department of Transportation of the Northwest Territories; or
the Department of Community Government and Transportation of the Territory of Nunavut.
List B:
(1)
(2)
(3)
(4)
(5)
(6)
†
Birth Certificate
Social Insurance Number (SIN) card
Provincial Health Card (except for Ontario, PEI, Manitoba and Quebec*)
Signed credit card issued by a member of the Canadian Payments Association †
Signed Canadian Institute for the Blind (CNIB) client card with a photograph
Certificate of Indian Status
For a list of CPA members, refer to www.cdnpay.ca
Notes:
i) All identification documents must be current to be acceptable.
ii) We can accept an individual’s provincial health card, but only if it is not prohibited by provincial or territorial legislation.
iii) Currently Ontario, Manitoba and P.E.I. prohibit use of the health card for identification purposes. *In Quebec, we cannot
request to see a client’s health card, but we may accept it if the client wants to use it for identification purposes.
iv) Valid foreign ID, if equivalent to an acceptable type of Canadian identification document, is acceptable.
v) Where the individual is not physically present in Canada, a third party (e.g., lawyer, notary public, commissioner of oaths or
similar person) who is attesting to the individual’s identity on our behalf has to be properly instructed in writing to act as our
agent and has to complete and sign the IVF Form. In addition, the lawyer, notary public, commissioner of oaths or similar
person’s standing should be confirmed directly or through the Canadian consulate or embassy in that country. Alternatively,
the individual can attend the closest Canadian consulate or embassy and have his/her identification attested to. In such a
case, the officer at the consulate or embassy would have to complete and sign the IVF Form.
Politically Exposed Person (PEP):
A PEP is a person who is a “senior political figure”, any member of a senior political figure’s “immediate family,”, and any “close
associate” of a senior political figure.
A senior political figure is an individual who holds or has ever held in the past,
Canada or a foreign country:
o
o
o a head of state or government;
o
o a member of the executive council of government
o
or member of a legislature;
o
o a deputy minister (or equivalent);
o an ambassador or an ambassador’s attaché or
counselor;
one of the following offices or positions in or behalf of
a military general (or higher rank);
a president of a state owned company or bank;
a head of government agency;
a judge; or
a leader or president of a political party in a
legislature.
PEP also includes the immediate family members of any individual described below:
o spouse or common law partner;
o spouse’s or common-law partner’s mother or father.
o child; brother, sister, half-brother or half-sister;
o
mother or father; or
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Appendix B – Third Party Information Form
Complete for an Individual:
Full Name:
Address:
City:
Province:
Country:
Postal Code:
Occupation1:
Date of Birth:
1
Vague description such as “Business-for-Self”, “self-employed”, “consultant”, “investor”, “business owner”, “businessman”,
“entrepreneur” or “Signing Officer” is not acceptable. The occupation must clearly reflect the nature of the work and the
industry in which it is performed.
OR
Complete for a Corporation:
Name of Business:
Nature of Business:
Incorporation Number and Place of Issue:
Address:
City:
Country:
Postal Code:
What is the relationship between the registered owner of the property on closing and the Third Party?
 Agent
 Borrower
 Power of Attorney
 Employee
 Friend
 Relative
 Trustee
 Other (specify) ________________________________________________
Additional Comments:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Name of Person or Firm completing this form:
Signature:
Date:
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