Sample Institutional Form

The account holder would use a form to choose their personal wishes on their account. The financial institution would have to have this form filled out for a new account holder. Information would also be sent to all existing account holders letting them know they are eligible for this system at no cost to them.

The form provided by the institutions would be standardized and would include the following.

A         No participation desired. Requires a signature.

__________________________________________

B.        Participation desired.

1. Who will be your Trusted Advisor to receive the code?

_____________________________________________

Contact information for the Trusted Advisor.

Phone ___________________________

Email _____________________

2. Set up limit that would trigger notification to the Trusted Advisor.

$__________________per transaction

or cumulative to the above amount within __________days

3.Action to be taken if no response is received from the designated Trusted Advisor. (This could be another trusted party preferably an institution.) ________________________________

4. Choose who should be contacted for intervention should the account owner make a multitude of attempts of dangerous money transactions. (This would be a Person with potential Power of Attorney) _________________________________________

                    Contact info_____________________________

5. Approval to run requested transaction through government fraud list prior to going to Trusted advisor. (If it is on the fraud list it puts an automatic lockdown on the account and automatic notification to Trusted Advisor and account holder.)

Signature of acceptance____________________________

Signature of decline ________________________________