Pt. 504, App. C
Appendix C to Part 504—Certificate of Compliance With the Right to Financial Privacy Act of 1978—Sample Format
Manager, Army Federal Credit Union, Fort Ord, CA 93941.
Dear Mr./Mrs. _____: I certify, pursuant to section 3403(b) of the Right to Financial Privacy Act of 1978, section 3401 et seq., Title 12, United States Code, that the applicable provisions of that statute have been complied with as to the (customer's consent, search warrant or judicial subpoena, formal written request, emergency access, as applicable) presented on (date), for the following financial records of (customer's name):
(Describe the specific records)
(Official Signature Block)
Pursuant to section 3417(c) of the Right to Financial Privacy Act of 1978, good faith reliance upon this certificate relieves your institution and its employees and agents of any possible liability to the customer in connection with the disclosure of these financial records.