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SEVENTY A. KORSHUNOV, M.D. NEW PATIENT/UPDATE INTAKE FORMS All questions contained in this questionnaire are strictly confidential and will become part of your medical record. Last Name: First Name:
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Yevgeniy A is a form used for reporting information about certain foreign financial accounts.
US persons including individuals, corporations, partnerships, and trusts must file Yevgeniy A if they have financial interest or signature authority over foreign financial accounts.
Yevgeniy A can be filled out electronically through the Financial Crimes Enforcement Network's BSA E-Filing System.
The purpose of Yevgeniy A is to combat money laundering and tax evasion by tracking foreign financial accounts held by US persons.
Information such as account numbers, account balances, the name of the financial institution, and the maximum value of the account during the reporting period must be reported on Yevgeniy A.
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