Become a member - Postal & Partners Co-Operative Credit Union

Nomination Form

( PURSUANT TO THE CO-OPERATIVE SOCIETIES ACT)

Name of Credit Union:

Member Name:

Address:

Occupation:

A member of the above-named Credit Union, do hereby revoke any previous nomination made by me and do hereby Nominate the following person(s) (none of them being an Officer or Servant of the Credit Union, unless such person is the Husband, Wife, Father, Mother, Child, Brother, Sister, Nephew or Niece of me, the Nominator, to or among whom shall be transferred my property in the Credit Union, whether in shares, Loans, Deposits or otherwise in such proportions as is set forth below opposite their respective names.

Name:

Address:

Telephone Number:

Date of Birth:

Relationship:

Occupation

Proporation %

Name:

Address:

Telephone Number:

Date of Birth:

Relationship:

Occupation

Proporation %

I, further appoint the following person(s) as trustee(s) for the minor(s) nominated above until he or she attains the age of eighteen (18) (A Trustee appointed must be eighteen (18) years of age of older).

Name:

Address:

Telephone Number:

Date of Birth:

Relationship:

Occupation

Proporation %

Name:

Address:

Telephone Number:

Date of Birth:

Relationship:

Occupation

Proporation %

Name:

Date:

Signature of Member Nomination/Parent/Guardian:

Signature of Witness:

Address:

I declare that the present nomination was deposited with the Credit Union on:

Signature of Secretary or Designate of the Credit Union:

Select below:

Adult

Child

Member Number:

Date

Section A: Applicant Information

Title:

Mr.

Mrs.

Miss:

Other:

Marital Status:

Divorced:

Married:

Widowed:

Separated:

Single:

Sex:

Male:

Female:

TRN

Date

First Name

Middle Name

Last Name

Maiden Name:

Alias:

Present Home Address:

City/Town /District/P.O. Box/Postal Zone/Zip Code:

Parish/Milestone/Direrctions: (if applicable)

Mailing Address: (If different form above address)

Telephone Number: (Home)

Telephone Number: (Cell)

City/Town/District:

P.O. Box/Postal Zone/Zip Code:

Telephone Number: (Fax)

Email:

Parish:

Country:

Residential Status:

Own

Rent

Time at this Address:

Previous Home Address:

City/ Town District:

Number of Dependent:

P.O. Box/Postal Zone/Zip Code:

Country:

SECTION B: EMPLOYMENT STATUS & OTHER INFORMATION

Occupation/Job Title: (the terms”business man/woman - manager” are not acceptable

Full- Time

Contract

Student

Self Employed

Part-Time

Seasonal

Retired

Unemployed

Are you entrusted with a prominent public position such as senior government official, senior civil servant, politician, or military?

Yes

Are you immediately related to or closely associated with any person in any of the above-mentioned positions?

Yes

If yes explain:

Are you related to an employee, relative or volunteer of the Credit Union?

Yes

If yes, please name:

Relation:

Name of Employer/Business/School:

Employer/Business/School Address:

City/Town/District :

Telephone Number:

Source of Funds:

P.O. Box/Postal Zone/Zip Code:

Employed/Attending School Since:

Annual Salary/Income: ($)

Expected Deposit Amount:

Annually

Monthly

Fortnightly

Weekly

Parish:

Country:

Currency: ( for Income Received)

Section C: Family Information

Spouse:

Title:

Mr.

Mrs.

Miss:

Other

Marital Status:

Divorced

Widowed

Single

Married

Separated

First Name

Middle Name

Last Name

Present Home Address: (Street)

City/Town/District:

P.O. Box/Postal Zone/Zip Code:

Parish

Country:

Nationality:

Sex:

Male

Female

Date of Birth

Maiden Name:

TRN

Telephone Number ( Home)

Telephone Number (Work)

Telephone Number (Cell)

Telephone Number (Fax)

Emai:

Occupation:

Checkbox Field

Full-TIime

Contract

Student

Self Employed

Part Time

Seasonal

Retired

Name of Employer/ Business

Employed Since:

Address of Employer/Business:

City/Town/District:

P.O. Box/Postal Zone/Zip Code:

Parish:

Country:

Employed Since:

Is the spouse/parent/guardian expected to make lodgements to this account?

Yes

If yes, what is the Source of Funds?

Actual Yearly Salary/Income:

SECTION D: How Else Can We Contact You ( Nearest relative not living with you)

Title

Mrs

Miss

Other

Martial Status:

Divorced

Married

Widowed

Separated

Single

Sex

Male

Female

First Name

Middle Name

Last Name

Present Home Address

City/ Town District

Country

Nationality

Name of Employer/ Business/ School

Occupation / Job title

Employer/Business/School Address: (Street)

P.O. Box/Postal Zone/zip Code:

Parish:

Country:

Date of Birth

Maiden Name

Alias

TRN

Parish

Relation to applicant

Telephone Number (Home)

Telephone Number (Cell)

Telephone Number (Work)

Section E: Verification of Address

Recent original utility bill in the name of the applicant OR

Recent correspondence (within the last three (3) months in the applicant’s name and bearing the same address (from government, financial institution or place of employment)

Section F: Information for Reference(s)

Acceptable references include:

Credit Union Board/Commitee Member

Police Officer (Rank of Inspector or Higher

Manager of another Financial Institution where the applicant has in good standing (letter must state same)

Credit Union Employee at supervisory level, employed for more than one(1) year

Credit Union Member for more than two (2) years and in good standing

JP/Notary Public

Attorney-at-law

Minister of Religion

Medical Doctor

Principal

Employer(HR Manager or Higher)

Section F: Information for Reference(s)

Reference 1

Title:

Mr:

Mrs:

Miss:

Other:

First Name

Middle Name

Last Name

Present Home Address: (Street)

City/Town/District:

Parish:

Country:

Nationality:

Type of Reference:

Name of Employer/Business:

Telephone Number: (Home)

Telephone Number: (Cell)

Occupation/Job Title: (the terms “business man/woman - manager” are not acceptable)

Telephone Number: (work)

Email:

Employer/Business Address: (Street)

City/Town/District:

P.O. Box/Postal Zone/Zip Code:

Parish:

Country:

Reference 2:

Title:

Mr:

Mrs:

Miss:

Other:

First Name

Middle Name

Last Name

Present Home Address: (Street)

City/Town/District:

Parish:

Country:

Nationality:

Type of Reference:

Name of Employer/Business:

Telephone Number: (Home)

Telephone Number: (Cell)

Occupation/Job Title: (the terms “business man/woman - manager” are not acceptable)

Telephone Number: (work)

Email:

Employer/Business Address: (Street)

City/Town/District:

P.O. Box/Postal Zone/Zip Code:

Parish:

Country:

SECTION G: CITIZEN INFORMATION

Are you a citizen of the United States of America

Are you a United States of America Green Card Holder

Were you born in the United States of America

US Address: (Street)

City/Town/District

P.O. Box/Postal Zone/Zip Code:

US Telephone Number:

SECTION H: UPDATING ACCOUNT

In Keeping with government regulations, the personal information on all accounts maintained at the Credit Union MUST be updated every five (5) years, sooner or later as may be determined by government regulations.

SECTION I: CLOSING YOUR ACCOUNT

A member may be expelled and his/her accounts closed, if he/she acts in contravention of the Co-operative Societies Act regulations or Credit Union rules, acts in any way detrimental to the interests of the Credit Union, acts in contravention of legislation pertaining to deposit taking institutions, attempts to defraud the Credit Union or is convicted of a criminal act.

SECTION J: OBTAINING INFORMATION

I authorize the Credit Union to obtain additional information from other sources as deemed necessary.

Your Name:

the undersigned confirm that I have read and understand what is written in this document and also confirm that the information provided herein is true and correct. I authorize the CREDIT UNION to verify all information and to obtain from anyone any additional information that may be required to process this application. I hereby apply for membership in the CREDIT UNION and agree to conform to the rules and amendments thereof and subscribe to the required shares. It is my responsibility to inform the CREDIT UNION of all changes as they affect my member account status

Signature of Applicant:

Witness to Signature of Applicant:

Name of person Recommending Applicant:

Name of Parent/Guardian: (Child)

Signature of Parent/Guardian: (Child)

Name of Director, Volunteer or Staff member Recommending Applicant:

Signature of Director, Volunteer or Staff member Recommending Applicant:

This applicant was approved and entered in the Minute Book at a Meeting of the Board of Directors held:

President or Designate:

Secretary Designate:

Herewith please find the sum of $

Permanent Shares:

Voluntary Shares:

Entrance Fee:

Book of Rules:

Identification Card:

Total: