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    Poa Cert Form

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    tina
    This document provides a form and instructions for certifying a power of attorney to add an agent or attorney-in-fact to a Synchrony Bank account. The agent must provide identification information and certify that the power of attorney document appointing them as agent has not been revoked and is in full force.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Poa Cert Form

    Uploaded by

    tina
    52 views3 pages
    This document provides a form and instructions for certifying a power of attorney to add an agent or attorney-in-fact to a Synchrony Bank account. The agent must provide identification information and certify that the power of attorney document appointing them as agent has not been revoked and is in full force.

    Original Description:

    Power Of Attorney certification form

    Original Title

    poa-cert-form

    Copyright

    © © All Rights Reserved

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    This document provides a form and instructions for certifying a power of attorney to add an agent or attorney-in-fact to a Synchrony Bank account. The agent must provide identification information and certify that the power of attorney document appointing them as agent has not been revoked and is in full force.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    52 views3 pages

    Poa Cert Form

    Uploaded by

    tina
    This document provides a form and instructions for certifying a power of attorney to add an agent or attorney-in-fact to a Synchrony Bank account. The agent must provide identification information and certify that the power of attorney document appointing them as agent has not been revoked and is in full force.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    FORM TO ADD AN AGENT OR ATTORNEY-IN-FACT UNDER A POWER OF ATTORNEY

    This document must be signed and notarized. We also require a complete copy of the
    documentation to support the request to add an Agent/Attorney-in-Fact under a Durable Power of
    Attorney. Please do not send the original documents, as we employ secure shredding procedures
    and it will not be returned.

    We will be able to process your request once we receive the document(s).

    Please send completed form and documents to:


    Synchrony Bank

    P.O. Box 669802

    Dallas, TX 75266-0955

    We're here to help. If you have any questions, please contact one of our Bankers toll-free at
    1-866-226-5638.

    Thank you for choosing Synchrony Bank!

    Synchrony Bank Customer Service

    POACOVERAOS_WEB
    REV. [12/2022] Member FDIC
    Power Of Attorney Certification Form
    All financial institutions are required by the federal USA PATRIOT Act to obtain, verify, and record information that identifies each
    person seeking to open an account with Synchrony Bank, which includes an agent under a power of attorney seeking to be added to
    an account. As a result, when you request to be added on an account under a power of attorney, we will ask for your name, address,
    date of birth, taxpayer identification number, and other information that will allow us to identify you, such as a driver’s license or
    other identifying documents.

    By signing this document, the Agent/Attorney-in-Fact named below certifies that:


    (1) This form is for the following customer:

    Customer Name

    Customer Address (No P.O. Box please) City/State ZIP Code

    (2) The Agent’s/Attorney-in-Fact’s personal information is:

    First Name Last Name Social Security Number Date of Birth Country of Citizenship

    Home Address (No P.O. Boxes please) City/State ZIP Code Years at Address

    Previous Address (If less than 5 years at above address) City/State ZIP Code

    Mailing Address (If different from above) City/State ZIP Code

    Home Telephone Email Address

    Employer Name Occupation Business Telephone

    Driver’s License or other State ID Number State of Issue Issue Date Expiration Date

    (3) Are there any other Agents or Attorneys-in-Fact serving other than you? YES NO
    If your answer is yes, each Agent or Attorney-in-Fact will need to complete a Power of Attorney Certification Form and will be
    added to all of the customer’s accounts.
    (4) The Power of Attorney document appointing you as Agent/Attorney-in-Fact has not been revoked and is in full force
    and effect.
    (5) You will refund to Synchrony Bank any amounts erroneously distributed from any of the customer’s accounts at any time.
    (6) The customer named above is currently living.
    (7) You will promptly notify Synchrony Bank: (a) if you are removed as the Agent or Attorney-in-Fact for the customer; or (b) of the
    customer’s death; and
    (8) You, Individually and as the Agent or Attorney-in-Fact for the customer named above, release, discharge, indemnify and hold
    Synchrony Bank harmless against all claims, suits, causes of action, damages, losses, expenses, legal fees, costs and any
    other liabilities that Synchrony Bank may be subject to as a result of, or in connection with, any transactions or instructions
    initiated or provided by you with regard to the customer or any of the customer’s accounts.

    POACERTFORM_WEB
    [REV. 12/2022]
    TO BE SIGNED BY THE AGENT/ATTORNEY-IN-FACT

    X
    Signature of the Agent/ Attorney-In-Fact Printed Name of the Agent/ Attorney-In-Fact

    NOTARIAL ACKNOWLEDGEMENT

    State of ______________________________________________________________:

    County of ______________________________________________________________:

    Sworn to and acknowledged before me, __________________________________________________ by the individual named above on this
    (Notary)

    __________ day of _____________________________, 20________.

    X
    (Notary Signature)

    My Commission Expires: __________________________________

    POACERTFORM_WEB
    [REV. 12/2022]

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