Customer Identification Program (CIP) Verification Form

Records the identity verification steps performed when opening a new financial account under the Bank Secrecy Act and documents CIP compliance.

Submission Notice

• I understand this form collects PII for Customer Identification Program verification and compliance recordkeeping.
• Submission purpose
• Submitted by
• Submission date

Customer and Account Details

• Customer full name
• Date of birth
  Collect only if required by your institution's CIP policy and applicable law.
• Account type
• Account opening channel
• Internal customer or application reference

Identity Information Collected

• Customer type
• Identity elements collected for an individual
• Identity elements collected for a business or entity
• Identity documents reviewed

Verification Method and Results

• Verification method used
• Verification result
• Verification date
• Reviewer name
• Reviewer title

Exceptions and Follow-Up

• Reason for exception or unresolved mismatch
• Additional steps taken
• Escalation required
• Escalation owner

Compliance Attestation

• CIP verification completed in accordance with institution policy
• I understand this record will be retained as part of the compliance audit trail.
• Approver or compliance reviewer
• Approval date