Membership Application
Submitted On:
This is a secure application but if you are uncomfortable providing your National Insurance Number here you may call us with this info after submission. We cannot process your application without this information.
Branches:
Nassau
Abaco
Freeport
Other
Interested in:
Share Account
Savings
Individual Retirement
Club Accounts
Visa Debit Card
Youth Accounts
Regulatory Details:
Savings/Investments
Debt Servicing
Bill Payment
ATM Cash Withdrawals
Retirement
Education Fund
Other
Please Specify:
Employment
Pension
Self-Employed Business
Investments
Inheritance
Other
Please Specify:
0 - $4,999
$5,000 - $14,999.99
$15,000 - $49,999.99
$50,000 - $199,999.99
Over $200,000
(If more than $10,000 a Source of Funds Declaration is required)
Expected Monthly Transactions: $
Average Balance or Balance Range:
Daily
Weekly
Monthly
Expected Transaction:
Daily
Weekly
Monthly
Declaration of U.S. Citizenship or U.S. Residence for Tax Purposes

I confirm that I am a U.S. Citizen and/or resident in the U.S. for tax purposes.

I confirm that I was born in the U.S. but I am no longer a U.S. Citizen as I have voluntarily surrendered my citizenship; and my U.S. Certificate of Loss of Nationally is attached.

I confirm that I am not a U.S. citizen or resident in the U.S. for tax purposes.

Declaration
No
Yes
Politically Exposed Person (PEP) Declaration
No
Yes

Nomination of Beneficiary (Pursuant to "The Co-operative Society Act, 2005")

A member of the above Society, do hereby Nominate the following beneficiary as the only person or persons to or among whom shall be transferred my property in the Society, whether Shares, Deposits, or otherwise at my demise in such proportions as are set forth below opposite their respective names:

Name
Relationship
Occupation
Address
%
1
2
3
4
5

It is our aim to make the account opening process as easy as possible. To minimize and/or avoid delays, kindly ensure that you complete the requested information in full. All documents presented must be originals or certified photocopies that are clear and legible. For a photocopied document to be considered “certified”, a person of an approved profession (e.g. Justice of the Peace, Lawyer, Account or Senior Banker) must certify it. In general, the Credit Union must maintain documents which verify your physical identity (photo), full and correct name, date of birth and place of birth. The recommended document is a current and valid Passport; however, the Member Services Representative can advise of alternate documents specific to your circumstances.