New Account Application Passbook Savings Account

School: ______

Child’s Full Name: ______

Teacher Name and Class #: ______

Social Security #: ______- ______- ______

Date of Birth: Month ______Day ______Year ______

Parent (Custodian) Full Name: ______

Parent Social Security #: ______- ______- ______

Parent Date of Birth: Month ______Day ______Year ______

Parent Address: ______City ______Zip ______

Parent Home Telephone #: ( ) ______- ______

Parent’s Mother’s Maiden Name: ______

(Please attach photo copy of Driver’s License)

Driver’s license #:______State issued: ______

Issue Date: ______- ______- ______Expiration Date: ______- ______- ______

Employer:______Address:______

Work Telephone #: ( ) ______- ______

Please complete and return this form with a copy of the parent’s or custodian’s ID, and cash or check (check payable to your child) as an opening deposit in the envelope provided. Upon receipt and verification, we will return the Passbook with a signature card and envelope (for future deposits). We will also include the required disclosures. You may also fill out the paperwork at any of our Milford Offices. Future deposits may be made in currency and/or checks through the Cent$ible Kids Savings Program at participating schools. Addi- tional deposits are welcome at any of our offices. Thank you for enrolling your child in this special program which will teach them the benefits of saving!

Please call us at 203-783-5700 if you have any questions.

Member FDIC Do you already have a Milford Bank Passbook Account?

Yes, I have a Milford Bank Passbook Savings Account and want to participate!

Account #: ______

Child’s Full Name: ______

School: ______

Teacher Name and Class #: ______

Parent’s Signature: ______

USA Patriot Act

Important Information about procedures for opening a new account:

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see a driver’s license or other identifying docu- ments. This law requires us to gather and maintain specific information on our customers.

Thank you for your assistance.

Redeem this coupon for a Free Savings Bank when you open a NEW Centsible Kids Savings Account!

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