School Savings Application

Please fill out the information requested on this form to open a school savings account for your child. Information requested is used to open your child's account, keep you advised of the program, and comply with US law only. Personal information is not provided to third parties for other purposes. All requested information is required to participate.

USA PATRIOT ACT INFO
The USA patriot act requires information that verifies each person opening an account. To help the US government for money laundering and terrorism activities, we appreciate your assistance in accurately completing these forms.

Check here to use an existing First Community Bank Account / Marque aquí para usar una cuenta bancaria existente de First Community

Parent or Guardian Information / Información de los Padres

* First Name / Nombre

Middle Name / Segundo Nombre

* Last Name / Apellido

* Phone / Teléfono

* Email / Correo Electrónico

* Date of Birth / Fecha de Nacimiento

* Tax ID / Identificación Fiscal

SSN

ITIN

* Physical Address / Dirección Física

* City / Ciudad

* State / Estado

* ZIP Code / Código Postal

Mailing address same as physical address / La dirección postal es la misma que la dirección física

* Mailing Address / Dirección Postal

* City / Ciudad

* State / Estado

* ZIP Code / Código Postal

Successor Custodian Information / Información del Custodio Sucesor

First Name / Nombre

Last Name / Apellido

Phone / Teléfono

Email / Correo Electrónico

Mailing Address / Dirección Postal

City / Ciudad

State / Estado

ZIP Code / Código Postal

Child's Information / Información del Niño/ de la Niña

* First Name / Nombre

Middle Name / Segundo Nombre

* Last Name / Apellido

* Date of Birth / Fecha de Nacimiento

* School / Escuela

* Tax ID / Identificación Fiscal

SSN

ITIN

* Grade / Grado

* Teacher / Maestro(a)

Parent or Guardian Identification / Identificación del padre o tutor

* Driver's license or ID / Licencia de conducir o tarjeta de identificación

Attach File / Adjuntar archivo

Disclosure / Divulgación

* By signing below, I hereby request that your financial institution open a custodial/uniform transfer to minor account in my name. I understand that additional accounts may be opened using this form so long as they are the same name and ownership form. I recognize that changes made to this account such as removing a signer or adding a signer, may require a change authorization and that change in the form of ownership may result. I agree to the terms of the applicable customer agreement. I certify that all the numbers/information shown on this form are correct. I am not subject to back up withholding by the IRS.

* Parent/Guardian Signature / Firma del Padre/Tutor

* Date / Fecha

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