Add Power of Attorney: 1. Account Holder Information

Add Power of Attorney
Use this form to add a Power of Attorney to an account. Do not use this form for Trust accounts. For Trust accounts, please call 1-888-
882-3837. Enter your information clearly using blue or black ink.
1. Account holder information
Name of account holder Security code (Required if submitting this request by fax)
Account number(s)
Address City State ZIP
Home phone Email
2. Add attorney in fact (Power of Attorney)

Note: This section should be completed by the agent being added. As part of the process of adding a new agent, we will conduct
a review of that individual including requesting his or her consumer report. The new agent, must sign this form. (If more than one agent is
being added, copy pages 1-2 as needed and return with form)
Personal information
Title First name M.I. Last name Suffix
Social Security number/TIN Date of birth
Home phone Mobile phone Email
Address information
Residential address (No P.O. boxes) City State Country ZIP

Is your residential address also your mailing address? Yes No (If no, provide your mailing address below.)
Mailing address (If different from above) City State Country ZIP
Security information
Your security code is a PIN, phrase or combination of letters and numbers that provides an added layer of security we use to help
verify your identity. You’ll be asked to provide your code when contacting us with questions about your account.
Create your security code (Must be 6-20 letters and/or numbers, no special characters. Do not use your Social Security number, date of birth or mother’s maiden name)
Security code hint (Enter a keyword or phrase to help you recall your code)
For security purposes and to help the government fight terrorism and money-laundering activities, Federal law requires all financial institutions to obtain, verify, and record information
that identifies each person who opens an account. For this reason, we will ask you for your name, address, date of birth, Social Security number or other Tax Identification Number,
and other information that will allow us to identify you. We may also ask other questions or request other documents meant to verify your identity.
Page 2 of 3
Citizenship information
I am a: U.S. citizen
U.S. resident alien (Please provide your country)
Non-resident alien (Please provide your country)
Are you authorized to work in the United States? Yes No
Employment information
Status: Employed Self-employed Retired Student/minor Not employed
Employer name Position or title Length of employment
3. Order new checks

Checks will only be issued in the name of the principal account holder(s).
Order checks. New checks will be the same style as your previous order; fees do apply.
4. Agreements and certifications

By signing section 5, and by maintaining a TIAA Bank account(s), I understand and agree that TIAA, FSB (“TIAA Bank”) will rely on
the veracity and completeness of the information on this form in opening or making the requested account change(s). I hereby
certify that the information provided on this form and any accompanying documentation is true, complete, and accurate and that I
will notify TIAA Bank of any material change in such information or statements. I agree/understand and certify to TIAA Bank that:
W I have read and agree to be bound by the terms and conditions of the account as set forth in the Personal Account Terms,
Disclosures and Agreements Booklet, the Deposit Account Fee Schedule, and any other disclosures or addenda related to the
accounts or services I have requested on this application, and to which I give my consent to TIAA Bank opening and/or
providing, each of which may be amended from time to time.
W I authorize you make any credit, employment, or other investigative inquiries you deem appropriate (including, without limitation,
obtaining a consumer report) in connection with your determination to open, renew, update, maintain, or collect on my account.
I understand that upon my request, TIAA Bank will provide information on whether a consumer report was obtained and the
names and addresses of any consumer-reporting agencies that provided such reports.
W I understand that you may report information about my account to credit bureaus. Late payments, missed payments, or other
default on my account may be reflected in my credit report. In addition, I understand that I am being notified, as required by
law, that a negative credit report reflecting on my credit record may be submitted to a credit reporting agency if I fail to fulfill the
terms of any credit obligations I may have to TIAA Bank.
W I understand that all information I supply when applying for an account or requesting new or additional products or services
becomes property of TIAA Bank and will not be returned, except as required by law.
The undersigned agrees that we, TIAA Bank, in our sole discretion, may accept documents that you have signed and sent to us by
electronic means, like fax, email, or other file transmittal processes we might offer. By sending us any such document by electronic
means, the undersigned agrees that we may rely on it and on the signature, and that the document is binding on the signer even if
the original signed document is not delivered to us.
Page 3 of 3
5. Signature(s)
By signing below the undersigned acknowledges and agrees to these terms and conditions.
Account holder Date
Attorney in fact Date
Check here if the principal is incapacitated.
6. Notary information
Attorney in fact signature Date
State of
County of
Subscribed and sworn before me this day of , 20 ,
by , who is personally known by me or who produced appropriate identification to me.
(SEAL)
Notary Public signature
Notary name (Print first and last name)
Notary state Commission expiration date
Commission number
7. Submit
Mail this entire form, a copy of the Power of Attorney (if applicable), and any additional documentation to:
TIAA Bank, PO Box 1284, Charlotte NC 28201-1284
For bank use only:

Verify client signature Date verified FC number Employee name (Print first & last name)
TIAA Bank® is a division of TIAA, FSB.

©2020 and prior years TIAA, FSB. 20MCM0670.10 ~ 206.1B ~ 10/20

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Add Power of Attorney

1. Account holder information

Address City State ZIP

Home phone Email

2. Add attorney in fact (Power of Attorney)

Title First name M.I. Last name Suffix

Social Security number/TIN Date of birth

Home phone Mobile phone Email

Residential address (No P.O. boxes) City State Country ZIP

Employer name Position or title Length of employment

3. Order new checks

4. Agreements and certifications

Account holder Date

Attorney in fact Date

Check here if the principal is incapacitated.

Attorney in fact signature Date

Subscribed and sworn before me this day of , 20 ,

by , who is personally known by me or who produced appropriate identification to me.

Notary name (Print first and last name)

Notary state Commission expiration date

For bank use only:

TIAA Bank® is a division of TIAA, FSB.

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