Blank certification of business records form for bank document submission

EFTA00193175¶

CERTIFICATION OF BUSINESS RECORDS¶

I, the undersigned,___, declare that I am: employed by/associated with ___in the position of ___and by reason of my position am authorized and qualified to make this declaration.¶

In my employment with the above-named bank/company I am familiar with the business records it maintains. The above-named bank/company maintains records of its business which are:¶

1. made at or near the time of the occurrence of the matters set forth therein, by, or from information transmitted by, a person with knowledge of those matters;

2. kept in the course of regularly conducted business activity; and

3. made by the regularly conducted activity as a regular practice.

Among the records so maintained are the attached records itemized in Appendix A, Inventory of Documents.¶

I declare under penalty of perjury that the foregoing is true and correct.¶

Date of execution: ___¶

Place of execution: ___¶

Signature: ___¶

EFTA00193176¶

APPENDIX A¶

DOCUMENT INVENTORY¶

The documents submitted are as follows:¶

Signature of Records Custodian:¶