ACH Origination Annual Training Certification Form

*Please note that this form is for business customers of First Community Bank only.

An ACH Origination Agreement has been executed between you and First Community Bank. The Agreement allows the origination and submission of ACH transactions using the secure system. As a condition of the service, customers are expected to install procedures that provide safe and sound ACH originations. Security and privacy procedures related to these transactions must be implemented to prevent the improper creation, approval, and submission of transactions to the bank. Your systems and procedures must also prevent the unauthorized access of the confidential information they may contain.

Use this worksheet as a tool for you, as the Company, to evaluate the risks and security issues related to ACH origination. All of your answers should be "Yes," and anything answered "No" should be addressed as soon as possible.

Contact First Community Bank's ACH Department at 251-847-2214 x 3031 should you require any assistance in completing this form. This form should be completed and submitted by September 20, 2014.


  • An ACH ODFI Origination agreement was executed with the bank that explains all your duties and obligations related to ACH origination Service. You know that the ACH Rules which govern this service can be obtained in your copy of the Corporate Rule Book or at at your own expense. You are only originating PPD or CCD entries. (If No, contact the bank to get entry approvals.)

    OK Required
  • An ACH authorization form for all customers, vendors, or employees that are receiving ACH's from you (either debits or credits) is on file and is kept in a secure location in your office. (If No, do not submit the entry until it is properly authorized.)

    OK Required
  • All ACH transactions are to US financial institutions only... No foreign countries.

    OK Required
  • All the security procedures for creating, balancing, approving and submitting the ACH transactions are conducted in accordance to the agreement/systems.

    OK Required
  • Adequate funds are in place to cover ACH transactions prior to the Effective Entry Date.

    OK Required
  • Appropriate steps are taken to ensure that all User ID's, Passwords, and authentication methods and any other applicable security procedure issued to your employees are protected and kept confidential. (If No, contact the bank to reset or establish unique IDs and passwords)

    OK Required
  • The Bank will be notified of any suspicious activity. Examples include: unexpected password compromise, unknown transactions, suspected embezzlement or other security incidents that might compromise your computer or network security.

    OK Required
  • All computer equipment used to operate ACH transactions is regularly updated and patched for security (including use of and updating of firewall, anti-virus protection, anti-malware protection, and anti-spam protection). In addition, such equipment is located in a reasonably secure location that permits access only to authorized personnel.

    OK Required


    I have read the above and understand that our company is responsible for all ACH's originated with User ID's issued to us. I also Certify that the representations made on this form are true and correct to the best of my knowledge.

  • OK Name is required
  • OK Title is required
  • (Must be an individual with signing authority on the Account at the Financial Institution)

Security Code

  • OK is required