CD Application Form

12-Month CD

Minimum balance to open $50,000 new money required.

Certificate of Deposit (CDs)

High-Yield CD

12 Month

3.90% + 1% $4.90%

$50,000 - $99,999

12 Month

3.90% + 1.20% $5.10%

$100,000 - $174,999

12 Month

3.90% + 1.30% $5.20%

$175,000 - $250,000

12 Month

3.90% + 1.45% $5.35%

$250,000 +

Personal Information

Joint Application

Yes

First Name

Last Name

Country of Birth

Nationality

Date of Birth

Upload ID

Country of residence for tax purposes

Are you a US Citizen

Yes

Social Security Number

If unavailable, provide a functional equivalent (eg TIN, Resident Registration Number, NI Number)

Address Information

Address Line 1

Address Line 2

City

State

Zip Code

Home Number

Mobile Number

Funding Information

Bank Name

Account holder's name

Bank Address

Bank Address 2

City

State

Zip Code

Routing Number

Account Number

CD Term & Rate Selection

Initial Deposit Amount

USD

Minimum deposit: $500.00

Funding Source

Interest Payout Frequency

Maturity Instruction

Beneficiary (Optional)

Beneficiary Full Name

Relationship

Beneficiary Date of Birth

Beneficiary SSN

Disclosures & Agreements

I acknowledge that this CD is FDIC-insured up to $250,000 per depositor and understand the insurance limitations.

I consent to receive account statements and disclosures electronically via email.

Under penalty of law, I certify that the information provided is accurate and that I am not subject to backup withholding.

Capital One, N.A., Member FDIC. Annual Percentage Yields (APY) are accurate as of the date of this publication and are subject to change without notice. Penalties may apply for early withdrawal. This application does not constitute a binding agreement until reviewed and approved by a bank representative.

Certificate of Deposit Application

12-Month CD