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Chapter 33 - Appendix P

Certificate of Compliance with The Right to Financial Privacy Act

To: <name and address of financial institution>

From: <name of regional director>
U.S. Department of Labor
Pension and Welfare Benefits Administration
<address>

I hereby certify that the applicable provisions of the Right to Financial Privacy Act of 1978, 12 U.S.C. §§3401-3422, have been complied with as to the subpoena presented on <date> for the following financial records of <name>:

Regional Director
U.S. Department of Labor
Pension and Welfare Benefits Administration
<address>
<telephone number>
<date>

Pursuant to the Right to Financial Privacy Act of 1978, good faith reliance upon this certificate relieves your institution and its employees and agents of any possible liability to the customer in connection with the disclosure of these financial records.