Membership Adverse Action Notice
Member:

Financial Institution:
IBM Southeast Employees' Federal Credit Union
P. O. Box 5090, Boca Raton, FL 33431-0890
800.873.5100 - 561.982.4700
serviceplus@ibmsecu.org

Date:

SSN/TIN:

Membership:

"We" means IBM Southeast EFCU. "You" means potential or current Member.

Description of Account, Transaction or Request:

[ ] New Membership Savings.

[ ] New Checking account.

[ ] New VISA Check Card.

[ ] Other:

Description of Action Taken:
This notice is to inform you that:
[ ] We are unable to approve your request.

[ ] We are unable to approve your request in its entirety.

We have approved your request for a:
[ ] Membership Savings.

[ ] Checking account.

[ ] VISA Check Card.

[ ] Other:

We were unable to approve your request for a:
[ ] Membership Savings.

[ ] Checking account.

[ ] VISA Check Card.

[ ] Other:

Principal Reasons for Action Taken:
Other Principal Reasons may have influenced our decision. Contact the Credit Union for further details.

] 1. A negative ChexSystems record reported within the past twelve (12) months, that contained a notice of account

[
abuse, fraud or unpaid monies owed to a financial institution.
[ ] 2. Derogatory activity on existing or previous IBM Southeast EFCU accounts within the past twelve (12) months.
( ) Check and/or ACH Non-Sufficient Fund (NSF), negative balance, overdrawn and/or delinquent accounts.
( ) Accounts that resulted in a financial loss to the Credit Union, including negative share and loan charge offs.

[ ] 3. Derogatory credit record reported within the past seven (7) years to Experian credit bureau.

Please see the reverse side of this notice for more information regarding your credit bureau record.

[ ] 4. Unable to verify:

(
) Social Security Number (SSN) or other Tax Identification Number (TIN) - Provide a legible photocopy of
your SSA Social Security Card, or IRS Employment Authorization Document, and a letter of verification from
the Social Security Administration (SSA) or the Internal Revenue Service (IRS).
(
unexpired government issued photo identification.
( ) Residential Address - Provide a legible photocopy of your utility bill or other document to be used to verify
your residential address.

) Driver's License or other identification - Provide a legible photocopy of your driver's license or other

[ ] 5. Other:

[ ] If checked, the number of inquiries was also a principal reason adversely affecting your request for Membership.

Disclosure of Use of Information Obtained from an Outside Source

Our decision was based in whole or in part on information obtained in a report from the consumer reporting agency or
agencies listed on the following page. You have a right under the
to know the
in our
information contained in your file at the consumer reporting agency. The reporting agency played no part
decision and is unable to supply specific reasons why we have denied your request. You also have a right to a free copy
of your report from the reporting agency, if you request it no later than sixty (60) days after you receive this notice. In
addition, if you find that any information contained in the report you receive is inaccurate or incomplete, you have the
right to dispute the matter with the reporting agency.

Fair Credit Reporting Act (FCRA)

Adverse Action - Notice of Action Taken
VMP
Bankers Systems
Wolters Kluwer Financial Services

*

,

-

Custom MDF. EFLDNFCR

1997, 2011 - IBM Southeast EFCU 10/2011

DN-FCRA-D 7/15/2011

Page 1 of 2

Notice of Action Taken [continued]

Name

Mailing Address

Telephone
Toll-Free

Web Address

ChexSystems, Inc.

Attn: Consumer Relations
7805 Hudson Road, Suite 100
Woodbury, MN 55125

800 - 428 - 9623

www.consumerdebit.com

Experian Information
Solutions, Inc.

P. O. Box 2002
Allen, TX 75013

888 - 397 - 3742

www.experian.com

Social Security
Administration

Office of Public Inquiries
Windsor Park Building
6401 Security Blvd.
Baltimore, MD 21235

For more information:

800 - 772 - 1213

www.ssa.gov

For more information about credit reports and your rights under federal
the Federal Reserve Board's
website at www.federalreserve.gov, or the Federal Trade Commission's web site at www.ftc.gov. To obtain a free
copy of your credit report, contact the Annual Credit Report Request Service.

law, visit

Annual Credit Report
Request Service

P. O. Box 105283
Atlanta, GA 30348-5283

877 - 322 - 8228

www.annualcreditreport.com

We also obtained your credit score from
, a
consumer reporting agency, and used it in making our decision. Your credit score is a number that reflects the
information in your consumer report. Your credit score can change, depending on how the information in your
consumer report changes.

Experian Information Solutions, Inc.

Your credit score:

Date:

Scores range from a low of

350

to a high of

900

.

Key factors that most adversely affected your credit score:
Other Key Factors may have influenced our decision. Contact the Credit Union for further details.

[ ] 1. Ratio of balance to limit on bank revolving or other revolving accounts is too high.
[ ] 2. Length of time that accounts have been established with the Credit Union is too short.
[ ] 3. Proportion of loan balances to loan amounts is too high.
[ ] 4. Derogatory public record or collection filed.
[ ] 5. Excessive obligations.
[ ] 6. Excessive unsecured debt.
[ ] 7. Credit bureau trade line history insufficient.
[ ] 8. Income insufficient.
[ ] 9. Tax lien, garnishment, judgment and/or levy.
[ ] 10. Other:

[ ] If checked, the number of inquiries was also a key factor adversely affecting your credit score.

If you have any questions regarding your credit score, you should contact
their address and telephone number above.

Experian Information Solutions, Inc.

at

Our decision was based in whole or in part on information obtained from an affiliate or from an outside source other than a consumer
reporting agency. Under the
, you have the right to make a written request, no later than sixty (60)
days after you receive this notice, for disclosure of the nature of this information. If you have applied for credit and your loan was
not approved as requested, you will receive a separate adverse action notice.

Fair Credit Reporting Act (FCRA)

If you applied for a loan at the same time you applied for Membership, you will receive a separate notice regarding your loan
request.
If you applied with a co-applicant who adversely affected your Membership approval, they will receive their own separate notice.

Adverse Action - Notice of Action Taken
VMP
Bankers Systems
Wolters Kluwer Financial Services

*

,

-

Custom MDF. EFLDNFCR

1997, 2011 - IBM Southeast EFCU 10/2011

DN-FCRA-D 7/15/2011

Page 2 of 2