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GREEN DOT BANK 6 DIGIT PRE-AUTHORIZED

ON LINE CARD – PROTOCOL 101


CARD HOLDER’S CLIENT INFORMATION SHEET

In accordance with Articles 2 and 5 of the Due Diligence and Federal Banking Commission Circular
of December 1998, concerning the Prevention of Money Laundering, and Article 305 of the Swiss
Criminal Code, the following information may be supplied to banks and to financial institutions for
purposes of verification of identity and activities of investing member, and the nature and origin of
the funds to be utilized.

Client Name Melton Kirk Tischler


Natinality Unided States of America
Residency California
Number Pasport 489341116
Date of Birth 01/06/1955

CARD INFORMATION

Bank Name Green Dot Bank

Card Name Melton Kirk Tischler

Card Expiry November/2024

Card Number 4143 9802 3064 7986

CVV 480

Acount Number GDB

Card Tape Visa

Currency U.S.A. Dollar

Total Amount $ 500.000.000,00

First tranche $ 250.000,00

Second tranche $ 750.000,00

Third tranche $ 49.000.000,00

Fourth tranche $ 100.000.000,00

Fifth tranche $ 150.000.000,00

Sixth tranche $ 200.000.000,00


CLIENT’S PASSPORT SCANNED COPY

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