DocuSign Envelope ID: 639C0B66-09BB-467C-9CA8-BA732C5EDDAF

Close Account Form

Shyam Sundar Ravikumar shyamsravikumar@gmail.com

Primary Member’s Name:
Account Number: 1822500

Identification Type: State ID State License X Passport

ID Number: V7109022

Please attach a picture of your ID with this request.

Please check the appropriate box(es) below:

X Close all of my accounts

Close my credit line Account must have a zero balance for 10 days prior to account closure
Credit Card Personal Line of Credit Home Equity Line Of Credit

How would you like the remaining funds?

In cash (In-Person Only)
In a check payable to the member (In-Person Only)
In a check payable to the member and mail it to the address below
X
Address: 123 Broadway Apt 423 City: Seattle
State: WA Country: USA Zip: 98122

To be transferred to an account at USC Credit Union

Account Name: Account Number:
To be wired to an account at another financial institution
Please fill out and attach the Wire Transfer Form and review the Schedule of Fees

By signing below, I authorize and agree to indemnify, defend, and hold USC Credit Union and its employees harmless from and against every
claim, demand, action, cost, loss, liability, and expenses including, without limitation, attorney’s fees, which you incur by acting in accordance
with USC Credit Union’s Account Agreement and Truth-In-Savings and Truth-In-Lending Disclosures (if applicable) or as a result of my failure to
abide by its terms. Mailed, e-mailed, and faxed forms must be submitted along with a legible copy of an unexpired identification document.
USC Credit Union will confirm all wire transfer requests submitted via email with a phone call.

12/27/2023

Primary Member Signature Date

THE CREDIT UNION DIFFERENCE

Better Better Better
RATES SERVICE LIFE
DocuSign Envelope ID: 639C0B66-09BB-467C-9CA8-BA732C5EDDAF
DocuSign Envelope ID: 639C0B66-09BB-467C-9CA8-BA732C5EDDAF
Certificate Of Completion
Envelope Id: 639C0B6609BB467C9CA8BA732C5EDDAF Status: Completed
Subject: Close Account Form - shyamsravikumar@gmail.com
Source Envelope:
Document Pages: 3 Signatures: 1 Envelope Originator:
Certificate Pages: 5 Initials: 0 USC Credit Union
AutoNav: Enabled PO BOX 512718
EnvelopeId Stamping: Enabled Los Angeles, CA 90051
Time Zone: (UTC-08:00) Pacific Time (US & Canada) docusign@usccreditunion.org
IP Address: 76.103.234.208

Record Tracking
Status: Original Holder: USC Credit Union Location: DocuSign
12/27/2023 | 10:49 AM docusign@usccreditunion.org

Signer Events Signature Timestamp

Shyam Sundar Ravikumar Sent: 12/27/2023 | 10:49 AM
shyamsravikumar@gmail.com Viewed: 12/27/2023 | 10:50 AM
Security Level: Email, Account Authentication Signed: 12/27/2023 | 10:54 AM
(None), Authentication
Signature Adoption: Pre-selected Style
Using IP Address: 76.103.234.208
Signed using mobile
Authentication Details
ID Check:
Transaction: 31026835788781
Result: passed Question Details:
Vendor ID: LexisNexis passed livedat.subdivision.fake
Type: iAuth passed corporate.association.fake
Recipient Name Provided by: Recipient passed corporate.association.fake
Information Provided for ID Check: Address, passed phonenumber.old.real
SSN9, SSN4, DOB passed vehicle.association.fake
Performed: 12/27/2023 | 10:50 AM passed person.known.single.fake
Electronic Record and Signature Disclosure:
Accepted: 12/27/2023 | 10:50 AM
ID: 2fa00a7b-f7a8-4b75-907e-83114b7692b2

In Person Signer Events Signature Timestamp

Editor Delivery Events Status Timestamp

Agent Delivery Events Status Timestamp

Intermediary Delivery Events Status Timestamp

Certified Delivery Events Status Timestamp

Carbon Copy Events Status Timestamp

Witness Events Signature Timestamp

Notary Events Signature Timestamp

Envelope Summary Events Status Timestamps

Envelope Sent Hashed/Encrypted 12/27/2023 | 10:49 AM
Certified Delivered Security Checked 12/27/2023 | 10:50 AM
Signing Complete Security Checked 12/27/2023 | 10:54 AM
Completed Security Checked 12/27/2023 | 10:54 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
Electronic Record and Signature Disclosure created on: 7/23/2021 | 10:48 AM
Parties agreed to: Shyam Sundar Ravikumar

ELECTRONIC RECORD AND SIGNATURE DISCLOSURE

From time to time, USC Credit Union (we, us or Company) may be required by law to provide to
you certain written notices or disclosures. Described below are the terms and conditions for
providing to you such notices and disclosures electronically through the DocuSign system.
Please read the information below carefully and thoroughly, and if you can access this
information electronically to your satisfaction and agree to this Electronic Record and Signature
Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to
use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign
system.

Getting paper copies

At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
to you through the DocuSign system during and immediately after the signing session and, if you
elect to create a DocuSign account, you may access the documents for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$3.00 per-page fee. You may request delivery of such paper copies from us by following the
procedure described below.

Withdrawing your consent

If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.

Consequences of changing your mind

If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to
receive required notices and consents electronically from us or to sign electronically documents
from us.

All notices and disclosures will be sent to you electronically

Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or made
available to you during the course of our relationship with you. To reduce the chance of you
inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.

How to contact USC Credit Union:

You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by phone call: (213) 821-7100
To contact us by email send messages to: usccu@usccreditunion.org
To contact us by paper mail, please send correspondence to:
USC Credit Union
PO Box 512718
Los Angeles, CA 90051

To advise USC Credit Union of your new email address

To let us know of a change in your email address where we should send notices and disclosures
electronically to you, you must send an email message to us at usccu@usccreditunion.org and in
the body of such request you must state: your previous email address, your new email
address. We do not require any other information from you to change your email address.

If you created a DocuSign account, you may update it with your new email address through your
account preferences.

To request paper copies from USC Credit Union

To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an email to usccu@usccreditunion.org and in the
body of such request you must state your email address, full name, mailing address, and
telephone number. We will deduct fees, if any, from your USC Credit Union account.

To withdraw your consent with USC Credit Union

To inform us that you no longer wish to receive future notices and disclosures in electronic
format you may:

i. decline to sign a document from within your signing session, and on the subsequent page,
select the check-box indicating you wish to withdraw your consent, or you may;

ii. send us an email to usccu@usccreditunion.org and in the body of such request you must state
your email, full name, mailing address, and telephone number. We do not need any other
information from you to withdraw consent.. The consequences of your withdrawing consent for
online documents will be that transactions may take a longer time to process..

Required hardware and software

The minimum system requirements for using the DocuSign system may change over time. The
current system requirements are found here: https://support.docusign.com/guides/signer-guide-
signing-system-requirements.

Acknowledging your access and consent to receive and sign documents electronically

To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please confirm that you have
read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for
your future reference and access; or (ii) that you are able to email this ERSD to an email address
where you will be able to print on paper or save it for your future reference and access. Further,
if you consent to receiving notices and disclosures exclusively in electronic format as described
herein, then select the check-box next to ‘I agree to use electronic records and signatures’ before
clicking ‘CONTINUE’ within the DocuSign system.

By selecting the check-box next to ‘I agree to use electronic records and signatures’, you confirm
that:

 You can access and read this Electronic Record and Signature Disclosure; and
 You can print on paper this Electronic Record and Signature Disclosure, or save or send
this Electronic Record and Disclosure to a location where you can print it, for future
reference and access; and
 Until or unless you notify USC Credit Union as described above, you consent to receive
exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to you by USC Credit Union during the course of your relationship with USC
Credit Union.