PB Wire Questionnaire

WIRE Questionaire

Customer’s Name:

Account Number:

Phone Number:

To protect our customers from becoming victims of fraudulent scams, we are asking you to complete this questionnaire. After completing this questionnaire, if you believe you are a victim of a scam, we can assist you with further information.

1) How did you meet the individual to whom you are wiring funds? How long have you known this individual. Is he/she a missionar y?

2) What is your relationship to the person you are sending funds to?

3) Are you sending funds to someone you have never met in person? q YES q NO

4) Did the funds for the wire transfer come from a recently deposited check, cashier’s check, money order, official check, or direct deposit/withdraw? q YES q NO

5) Ar e you wiring money in response to an offer that you received via the internet (email), through the mail or by phone? q YES q NO

6) Is the intended wir e necessary to claim lottery or prize winnings, an inheritance from overseas, to help finish a gas line or hospital in a 3rd world country, secret shopper work, etc.? q YES q NO

7) Were you instructed to wire money from an individual who identified themselves as being from a Law Enforcement Agency (Police; Sheriff’s Dept.; I.R.S.; D.E.A.)? q YES q NO

8) Were you instructed to wire money from an individual who identified themselves as a bank employee? q YES q NO

9) Were you instructed to wire money for accidental overpayment or unexpected taxes or transfer fees, etc.? q YES q NO

10) Are you wiring money as the result of an email, phone call or text message, such as a subscription renewal or computer virus caused by clicking on a link? q YES q NO

11) Have you been instr ucted by another person to invest/move these funds into cryptocurrency (Bitcoin)? q YES q NO

12) Ar e you sending funds for bail or bond for a grandchild or other family member? q YES q NO

13) Have you been instr ucted by another person to invest/move these funds into cryptocurrency (Bitcoin)? q YES q NO

14) Have you been instructed to keep the transaction a secret or mislead the bank employees r egarding the purpose of the funds? q YES q NO

Customer Signature Date

Employee Signature

Date

NOTE: If any of the above questions were answered “yes” or provided false information and you proceed with this request against our recommendation not to, you acknowledge that The Paducah Bank and Trust Company has informed you of the risks. These types of transactions are fraudulent in most cases and the money wired is not recoverable. You will be held responsible for any overdrafts that may occur as a result of this transaction.