CONSUMER REINSTATEMENT QUESTIONNAIRE

Dear Consumer,

Western Union values your business. We closely monitor the use of our money transfer services by our
consumers to comply with industry standards and regulations. In this case we will need some additional
information from you to proceed with your reinstatement request.

 Step 1- “COMPLETE”
Please complete the Consumer Questionnaire below and email the completed form to
GCR@westernunion.com. Please include supporting documents such as additional information
about your source of funds, the purpose of your transaction and the sender(s)/receiver(s) of the
money. These documents will be used to support your responses in the questionnaire.

 Step 2- “Review”
Once we receive the completed Consumer Questionnaire and supporting documents we will review
your information and make a decision regarding your reinstatement request. This process typically
takes between 5-7 business days.

 Step 3- “EMAIL/FAX”
We will inform you of the outcome using the email provided on the Consumer Questionnaire. Please
make sure the contact information you provide on the Consumer Questionnaire is accurate so that
we are able to reach you for follow up. See details on page 5.

We will only be able to perform the review if all information is complete and all supporting documents
are provided.

Please also note that we may need to contact you for additional information before a final decision can
be made. All documents received will remain confidential and will only be used for Western Union
internal purposes.

Thank you for choosing to be a Western Union consumer.

1
 CONSUMER REINSTATEMENT QUESTIONNAIRE

I. Please provide your personal information:

Recent MTCN: 7437020256

Full Legal Name (First, EFE
Middle,
Last/Family/Surname): ONOMAKE
A.K.A.s (Also Known
As, Nickname):
Street Address ONNUT SOI 20 SUKHUMVIT
City BANGKOK
State/Province/County BANGKOK
Postal Code/Zip Code 10250
Country THAILAND
Email address: efewest@yahoo.com
Primary Phone #: 0826331748
Secondary Phone #:
Date of Birth
8/30/1980
(mm/dd/yyyy):
Occupation: student

II. Please provide the following information for the people that you have sent to or received from the
most frequently or recently:

Have you met

What is your
What was the purpose him/her in
Name relationship with this
of the transaction(s)? person (face to
individual?
face)? Y/N
Lea hernandez Purchaser/Seller of
1 Purchase of Goods No
macawili Goods/Services
2 : : :
Purchaser/Seller of
3 Indriyani Purchase of Goods No
Goods/Services
4 : : :
5 : : :
6 : : :

2
 CONSUMER REINSTATEMENT QUESTIONNAIRE

III. What is your primary source of funds?

We need this information in order to better understand how you are funding your transaction(s).

Source of Funds If other, explain here:

www.efewest.com
fashion apparel and garments
and sales

Please attach to this request the necessary documentation to support your source of funds.

IV. Business or Individual Details

Are any of the transactions being conducted on behalf of a Business or an Individual other than
yourself?
☐No

If the answer is “Yes”, please provide the information below:

Describe your relationship

with the business or other
individual
Explain why are you acting
on behalf of the business or
other individual
Individual’s full legal name or
Business Name:
Street Address
City
State/Province/County
Postal Code/Zip Code
Country
Phone #:
Date of Birth (Not applicable
Click here to enter a date.
for business):
Individual’s Occupation or
Business Type:

3
 CONSUMER REINSTATEMENT QUESTIONNAIRE

V. Please check the relevant boxes for any documents that you are attaching to your request.

1.Invoices
2☐Bank Statement
3.Receipts to validate the expenses
4☐Travel Itinerary
5☐Contracts
6.Business/Non-Profit License
7☐Paystubs/W2-Form
8☐Other, specify below

If you selected other, please specify:

VI. Please include any additional information that may assist in our decision.

INSTRUCTIONS – GUIDELINE OF DOCUMENTS TO PROVIDE

Please provide documents to support your use of Western Union Money Transfer Services. Below are
examples of various documents that you may consider providing, however any other relevant
documentation to support the purpose of your transactions would be useful:

Based on the following transaction scenarios the nature of the documentation may vary:

Examples of Supporting
Purpose Possible Expenses
Documents
a. Mortgage Payment  Invoices
b. Sending to Self  Bank Statement
Financial Support/Personal c. Travel/Vacation  Receipts to validate the
Expenses expenses
Expenses/Charity/Business
d. Personal/Business  Travel Itinerary
Expenses  Contracts Business/Non-
e. Payroll Profit License

4
 CONSUMER REINSTATEMENT QUESTIONNAIRE

 Paystubs/W2-Form

Please be advised:

1- Providing as much information as possible will expedite the processing of your request.
2- We may contact you for additional information.
3- Providing all the requested information does not guarantee approval of your request.
4- Please attach all supporting documentation to the email to GCR@westernunion.com or sent by
fax to “1-866-421-8272” together with the completed questionnaire. Please make sure all
scanned documents are legible. All documents received will remain confidential for Western
Union internal use only.