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Customer Access Request Form

This document is a customer access request form for Western Union. It requests the customer's contact information, previous addresses, the type of information being requested such as transaction history or account details, and a copy of a government issued ID for verification purposes. The customer must sign and date the form to certify the accuracy of the information provided and that the request is being made on their own behalf. Upon verification, Western Union will provide the requested information to the customer's address on file within 10 business days.

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5K views

Customer Access Request Form

This document is a customer access request form for Western Union. It requests the customer's contact information, previous addresses, the type of information being requested such as transaction history or account details, and a copy of a government issued ID for verification purposes. The customer must sign and date the form to certify the accuracy of the information provided and that the request is being made on their own behalf. Upon verification, Western Union will provide the requested information to the customer's address on file within 10 business days.

Uploaded by

Olavo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Customer Access Request Form

Section I: Customer Information


Please complete all of the relevant information below. Failure to complete each applicable section to this request may
result in a delay to process this Customer Access Request.
Name:______________________________________ MyWU / Gold Card Number:_________________________
Postal/Street Address:__________________________________________________________________________
City:_________________________________________ State / Province:_________________________________
Postal Code:___________________________________ Country:_______________________________________
Additional Address Information (if applicable):______________________________________________________
Phone Number:_________________________________ Mobile Number:________________________________
E-Mail Address:_________________________________ Business Name (if applicable):_____________________

Section II: Previous Addresses (use additional sheets if necessary)


Please indicate any previous addresses you may have used while using Western Union services. Attach any additional
previous addresses if needed.
Proof of address is required if your address is not shown on your ID Document(s)

Previous Address 1
Postal/Street Address:__________________________________________________________________________
City:_________________________________________ State / Province:_________________________________
Postal Code:___________________________________ Country:_______________________________________
Additional Address Information (if applicable):______________________________________________________
Previous Address 2
Postal/Street Address:_________________________________________________________________________
City:_________________________________________ State / Province:_________________________________
Postal Code:___________________________________ Country:_______________________________________
Additional Address Information (if applicable):______________________________________________________

Western Union Confidential

Customer Access Template March 2014

Customer Access Request Form


Section III: Information Requested
Please indicate what information you are requesting Western Union to release by checking the appropriate box(es)
below. Keep in mind that Western Union will only release information on file as it relates to you and only retains
information for as long as what is required by law.

Transaction History, Specify Date or Date Range:____________________________________


Account or Other

Information

Name of individuals you have sent or received money


from______________________________________________________________________________________________
__________________________________________________________________________________________________
Please provide any reference numbers (eg MTCN) or other information that can assist us in providing the details you are
seeking: _____________________________________________________________________________________

Section IV: ID Verification


Please attach to this form a legible copy of a government-issued identification. This document will be used to verify your
identity prior to the release of any information from Western Union. Examples of acceptable forms of identification
include, but are not limited to:
If you have used more than one ID document to make a Western Union transactions or sign up for product or service,
you should provide a copy of each ID Document used so that we locate your personal data and confirm that the personal
data relates to you.

Drivers License
State or National I.D. Card

Passport

Military I.D. Card

Permanent Resident Card

Important: We recommend you return this form and the supporting documents in a secure envelope or send through
secure electronic means. If your ID does not show your current address, additional proof of address document such as
telephone bill, utility bill or similar documentation.
Upon receipt of your request and identification verification, Western Union will provide the requested information to your postal
address on file. Please allow ten business days for us to process your request.
By signing below, you certify and assert that the information provided within this document is as accurate and factual as reasonably
possible, reflects your own identity, and that this request is being made only on your own behalf.

Signed:_________________________________________

Date:________________________________

Print Name:_____________________________________
Western Union Confidential

Customer Access Template March 2014

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