Saving Application Form

Savings Application Form

Date of Application:

Account #:

TRN:

Section A- Member Information

Member Name:

Date of Birth:

Gender:

Choose a saving plan

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Contact Number:

Email Address:

Name of Designated Beneficiary

Relation:

Beneficiary Contact Number:

Name of Trustee:

Trustee Contact Number:

Section B- Savings / Investment Details

Amount:

Period of Savings:

16 Weeks

24 Weeks

36 Weeks

Interest rates/ Returns:

Members Declaration:

I confirm that the information given is true in all respects, accurate and complete, and that I have not withheld any information that might affect Credit Union's decision. I agree that early cancellation of the savings plan will result in interest/ results not being applied. I also indemnify the PCCUL of any liability resulting in my inability to contribute weekly/ fortnight/ monthly to this savings plan.

Name ( Member):

Signature:

Date: