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

Membership Form

Nomination Form

( PURSUANT TO THE CO-OPERATIVE SOCIETIES ACT)

Name of Credit Union:Member Name:I: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:OccupationProporation %Name:Address:Telephone Number:Date of Birth:Relationship:OccupationProporation %

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:OccupationProporation %Name:Address:Telephone Number:Date of Birth:Relationship:OccupationProporation %Name:Date:Signature of Member Nomination/Parent/Guardian:Signature of Witness:Signature of Witness:Address: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 ChildMember Number:Date

Section A: Applicant Information

Title: Mr. Mrs. Miss: Other:Marital Status: Divorced: Married: Widowed: Separated: Single:Sex: Male: Female:TRNDate First NameMiddle NameLast NameMaiden 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 RentTime 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 UnemployedAre you entrusted with a prominent public position such as senior government official, senior civil servant, politician, or military? Yes NoAre you immediately related to or closely associated with any person in any of the above-mentioned positions? Yes NoIf yes explain:Are you related to an employee, relative or volunteer of the Credit Union? Yes NoIf 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 WeeklyParish:Country:Currency: ( for Income Received)

Section C: Family Information

Spouse:Title: Mr. Mrs. Miss: OtherMarital Status: Divorced Widowed Single Married SeparatedFirst NameMiddle NameLast Name Present Home Address: (Street) City/Town/District: P.O. Box/Postal Zone/Zip Code:ParishCountry:Nationality: Sex: Male FemaleDate of BirthMaiden Name:TRNTelephone Number ( Home)Telephone Number (Work)Telephone Number (Cell)Telephone Number (Fax)Emai:Occupation:Checkbox Field Full-TIime Contract Student Self Employed Part Time Seasonal RetiredName of Employer/ BusinessEmployed 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 NoIf yes, what is the Source of Funds? Actual Yearly Salary/Income: Actual Yearly Salary/Income:

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

Title Mr Mrs Miss OtherMartial Status: Divorced Married Widowed Separated SingleSex Male FemaleFirst NameMiddle NameLast NamePresent Home AddressCity/ Town District CountryNationalityName of Employer/ Business/ School Occupation / Job title Employer/Business/School Address: (Street)P.O. Box/Postal Zone/zip Code: Parish: Country:Date of BirthMaiden NameAliasTRNParishRelation to applicantTelephone Number (Home)Telephone Number (Cell)Telephone Number (Work)Email

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 NameMiddle NameLast NamePresent 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:

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 AmericaUS 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: