Anti-Terrorism
Compliance Policy
In compliance with the USA PATRIOT Act and other counter-terrorism laws, the United Way of
Western Connecticut, Inc. requires that each agency certify the following:
“I hereby certify on behalf of _____________ _ _______
[name of grantee] that all United Way funds and donations will be used in compliance with all applicable anti-terrorist financing and asset control laws, statutes and executive orders.”
_____________ ________________________________
Date Executive Director/Chief Professional Officer
_______________
Date
_____________________________________
Board of Director’s Chairperson or CEO/President
Agency Mailing Information (for receipt of funds):
EIN#_______________
Agency Name: __________________________________________________________
Street: _______________________________________________________________
City: _______________________________ State: ___________ Zip: ______________
Agency Contact Information:
Name: _______________________________________
Phone: _______________________________________
Email: _______________________________________