EFTA00133751 Page 1
Account Number:
Branch:101
Account Type:General Membership
Member Group:0
Restricted Access:Normal
Open Date:01/20/2004
Last FM Date:09/03/2019
Record Change Date:09/03/2019
Activity Date:09/04/2019
Purged Rec Activity Dt:02/04/2016
Correspondence Date:01/21/2004
Proxy Date:/ / /
Close Date:/ / /
FM History Purge Date:04/30/2019
Reference:
Membership Status:Natural Person
Commercial Code:Consumer
Check Hold Base Amount:0.00
Check Dep Total Amount:0.00
Check Dep Total Date:/ / /
Non-Reg CC Check Hold Base Amt:0.00
Non-Reg CC Check Dep Total Amt:0.00
Enable Floats:No CU Float allowed
Current Relationship Code:0
Relationship Code:Regular
Relationship Override:Regular
Rel Override Eff Date:/ / /
Rel Override Exp Date:/ / /
Head of Household:Head of Household
Household Account:
Household Statement:Do not consolidate statement
Statement Mail Code:Use individual mail codes
E-Statement Email Notify:No E-mail notification
E-Statement Enable:Enable E-Statement only
State Reporting:
Created By User:9999
Created At Branch:0
US Cash Rcvd Amount:0.00
US Cash Disb Amount:0.00
Frgn Cash Rcvd Amt:0.00
Frgn Cash Disb Amt:0.00
Frgn Cash Rcvd Units:0.00
Frgn Cash Disb Units:0.00
Wire Received Amount:0.00
Wire Disbursed Amount:0.00
Warnings:Warning 01 Expiration:01/20/2012
Warning 01 Code:DELINQUENT LOANWarning 02 Expiration:03/29/2017
Warning 02 Code:RECENT ADDRESS CHANGEWarning 03 Expiration:___/___
Warning 03 Code:<None>Warning 04 Expiration:___/___
Warning 04 Code:<None>Warning 05 Expiration:___/___
Warning 05 Code:<None>Warning 06 Expiration:___/___
Warning 06 Code:<None>Warning 07 Expiration:___/___
Warning 07 Code:<None>Warning 08 Expiration:___/___
Warning 08 Code:<None>Warning 09 Expiration:___/___
Warning 09 Code:<None>Warning 10 Expiration:___/___
Warning 10 Code:<None>Warning 11 Expiration:___/___
Warning 11 Code:<None>Warning 12 Expiration:___/___
Warning 12 Code:<None>Warning 13 Expiration:___/___
Warning 13 Code:<None>Warning 14 Expiration:___/___
Warning 14 Code:<None>Warning 15 Expiration:___/___
Warning 15 Code:<None>Warning 16 Expiration:___/___
Warning 16 Code:<None>Warning 17 Expiration:___/___
Warning 17 Code:<None>Warning 18 Expiration:___/___
Warning 18 Code:<None>Warning 19 Expiration:___/___
Warning 19 Code:<None>Warning 20 Expiration:___/___
Warning 20 Code:<None>
**Payment History:** | Payments Made: | 120 | | :--- | :--- | | 16-30 Days DQ: | 0 | | 31-60 Days DQ: | 0 | | 61-90 Days DQ: | 0 | | 91-120 Days DQ: | 0 | | 121 and up Days DQ: | 0 | **Audio/HB Security:** | Audio/HB Frozen Mode: | Audio/HB is not frozen | | :--- | :--- | | Invalid Attempt Count: | 0 | | Last Inv Attempt Date: | 04/02/2019 | | Last Inv Attempt Time: | 05:16 AM | **NSF History:** | NSF Month 01 Day Count: | 0 | | :--- | :--- | | NSF Month 02 Day Count: | 0 | | NSF Month 03 Day Count: | 0 | | NSF Month 04 Day Count: | 0 | | NSF Month 05 Day Count: | 0 | EFTA00133752 ## Page 2
0NSF Month 18 Day Count:0
NSF Month 06 Day Count:0NSF Month 19 Day Count:0
NSF Month 07 Day Count:0NSF Month 20 Day Count:0
NSF Month 08 Day Count:0NSF Month 21 Day Count:0
NSF Month 09 Day Count:0NSF Month 22 Day Count:0
NSF Month 10 Day Count:0NSF Month 23 Day Count:0
NSF Month 11 Day Count:0NSF Month 24 Day Count:1
NSF Month 12 Day Count:1NSF Today Count:0
## Account ## Custom Fields: 09/04/2019 Privacy Option: Membership Source: Certified By: Marketing Promo Code: I EFTA00133753 ## Page 1 ## Member Name Information:
Title:
First Name:
Middle Name:
Last Name:
Suffix:
Name Format:
Preferred Contact:
Home Phone:
Work Phone:
Work Phone Ext:
Mobile Phone:
Phone Type:
Pager Number:
E-Mail Address:
Alt E-Mail Address:
Preferred Contact Method:
DBA Title:
DBA First Name:
DBA Middle Name:
DBA Last Name:
DBA Suffix:
DBA Name Format:
## Military APR Information: ## Member Address Information:
MBR Number Link:
MBR Number Link Chg Date:
License:
Address Verify Date:
Mail Override:
ECOA Code:
Beneficiary Percent:
Extra Information:
SSN Change Date:
SSN/TIN Override:
SSN/TIN Certification:
IRS Correction:
Amendment Number:
Credit Report Consumer Info:
Credit Rpt Consumer Date:
Use as Marketing Address:
## Name Record Information:
Active Duty:Not in Active Duty Service
Active Duty Verification Date:/ / /
Active Duty Start Date:/ / /
Active Duty Separation Date:/ / /
Identification 1:
Address Type:
Street:
City:
State:
Zip Code:
Documentary Flag 1: ID Type 1: ID Description 1: NY 11030-3331 10/08/2018 No override Individual 0.000% Documentary Identification State Drivers License NY 09/04/2019
Birth Date:
Death Date:/__/___
Sex:
Mother's Maiden Name:
SSN/TIN:
SSN/TIN Type:Individual SSN
U.S. Person Flag:U.S. Person
Current Employer:NEW YORK STATE/FEDERAL AGENCY
Occupation:
Curr Gross Mo Pay:0.00
Curr Net Mo Pay:0.00
Curr Mo Pay Last Updated:/__/___
Restricted Access:Normal
MBR Status:Member
FinCEN Information:
CTR Exempt:Not Exempt
Legal Entity Identifier:
Beneficial Owner Type:None
Beneficial Owner Percentage:0.000%
## Nonresident Alien Reporting:
IRS Country Code:
NRA Tax Rate:30.000%
NRA Exemption Code:
Form W-8 On File:No
W-8 Expiration Date:/ / / _
Foreign TIN:
Chapter 4 Status Code:23
GIIN:
Substantial Owner:No
LOB Code:
Extra Address:
Country:
Country Code:
Carrier Route:C006
ADDR Number Link:
ADDR Number Link Chg Date:___/___
Copy other Name:
Name Type:Primary
Name SubType:1
Name Change Date:___/___
Address Change Date:10/08/2018
Credit Rpt Address Change Date:10/08/2018
Effective Date:___/___
Expiration Date:___/___
Last FM Date:10/08/2018
MBR Last FM Date:02/27/2017
ADDR Last FM Date:10/08/2018
Confidential:Unclassified
Credit Rpt Address Indicator:
CR Address Indicator Date:___/___
Identification 2:
Documentary Flag 2:Non-documentary Identification
ID Type 2:Unknown
ID Description 2:
EFTA00133754 ## Page 2 ID Number 1: ID Issuance Date 1: ID Expiration Date 1: ID Verification Date 1: # Identification 3: Documentary Flag 3: ID Type 3: ID Description 3: ID Number 3: ID Issuance Date 3: ID Expiration Date 3: ID Verification Date 3: 09/04/2019 Custom Fields: Membership Card Order: MIP Verified: Place of Birth: Relation to Primary/Joint: ID Number 2: ID Issuance Date 2: ID Expiration Date 2: ID Verification Date 2: Non-documentary Identification Unknown