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APPENDIX A to Part 1005—Model Disclosure Clauses and Forms

A-1—Model Clauses for Unsolicited Issuance (section 1005.5(b)(2))
A-2—Model Clauses for Initial Disclosures (section 1005.7(b))
A-3—Model Forms for Error Resolution Notice (sections 1005.7(b)(10) and 1005.8(b))
A-4—Model Form for Service-roviding Institutions (section 1005.14(b)(1)(ii))
A-5—Model Clauses for Government Agencies (section 1005.15(e)(1) and (2))
A-6—Model Clauses for Authorizing One-Time Electronic Fund Transfers Using Information from a Check (section 1005.3(b)(2))
A-7—Model Clauses for Financial Institutions Offering Prepaid Accounts (section 1005.18(d) and (e)(3))
A-8—Model Clause for Electronic Collection of Returned Item Fees (section 1005.3(b)(3))
A-9—Model Consent Form for Overdraft Services (section 1005.17)
A-10(a)—Model Form for Short Form Disclosures for Government Benefit Accounts (sections 1005.15(c) and 1005.18(b)(2), (3), (6), and (7))
A-10(b)—Model Form for Short Form Disclosures for Payroll Card Accounts (section 1005.18(b)(2), (3), (6), and (7))
A-10(c)—Model Form for Short Form Disclosures for Prepaid Accounts, Example 1 (section 1005.18(b)(2), (3), (6), and (7))
A-10(d)—Model Form for Short Form Disclosures for Prepaid Accounts, Example 2 (section 1005.18(b)(2), (3), (6), and (7))
A-10(e)—Model Form for Short Form Disclosures for Prepaid Accounts with Multiple Service Plans (section 1005.18(b)(2), (3), (6), and (7))
A-10(f)—Sample Form for Long Form Disclosures for Prepaid Accounts (section 1005.18(b)(4), (6), and (7))
A-11 through A-29 [Reserved]
A-30(a)—Model Form for Pre-Payment Disclosures for Remittance Transfers Exchanged into Local Currency, including a disclaimer where non-covered third-party fees and foreign taxes may apply (section 1005.31(b)(1))
A-30(b)—Model Form for Pre-Payment Disclosures for Remittance Transfers Exchanged into Local Currency, including a disclaimer with estimate for non-covered third-party fees (section 1005.31(b)(1))
A-30(c)—Model Form for Pre-Payment Disclosures for Remittance Transfers Exchanged into Local Currency, including a disclaimer with estimate for foreign taxes (section 1005.31(b)(1))
A-30(d)—Model Form for Pre-Payment Disclosures for Remittance Transfers Exchanged into Local Currency, including a disclaimer with estimates for non-covered third-party fees and foreign taxes (section 1005.31(b)(1))
A-31—Model Form for Receipts for Remittance Transfers Exchanged into Local Currency (section 1005.31(b)(2))
A-32—Model Form for Combined Disclosures for Remittance Transfers Exchanged into Local Currency (section 1005.31(b)(3))
A-33—Model Form for Pre-Payment Disclosures for Dollar-to-Dollar Remittance Transfers (section 1005.31(b)(1))
A-34—Model Form for Receipts for Dollar-to-Dollar Remittance Transfers (section 1005.31(b)(2))
A-35—Model Form for Combined Disclosures for Dollar-to-Dollar Remittance Transfers (section 1005.31(b)(3))
A-36—Model Form for Error Resolution and Cancellation Disclosures (Long) (section 1005.31(b)(4))
A-37—Model Form for Error Resolution and Cancellation Disclosures (Short) (section 1005.31(b)(2)(iv) and (b)(2)(vi))
A-38—Model Form for Pre-Payment Disclosures for Remittance Transfers Exchanged into Local Currency
A-39—Model Form for Receipts for Remittance Transfers Exchanged into Local Currency—Spanish (section 1005.31(b)(2))
A-40—Model Form for Combined Disclosures for Remittance Transfers Exchanged into Local Currency—Spanish (section 1005.31(b)(3))
A-41—Model Form for Error Resolution and Cancellation Disclosures (Long)—Spanish (section 1005.31(b)(4))