Make your own free website on Tripod.com

Mr/Mrs/Ms/Miss Last Name___________________ First Name:___________________

Address:__________________________________________________________________

_______________________________________________ Post Code: __ __ __ __  | __ __ __

Home Telephone Number: __________|___________ Mobile 07_______|___________

E-Mail Address: ________________________ @ _______________________________ 

Date of Birth: _____ / ____ / _________  NI No: __ __|__ __ __ __ __ __|__

Password for account _______________________________

NEXT OF KIN / NOMINATED PERSON DETAILS: In the event of my death I
nominate the under-mentioned as the person to whom there shall be
transferred such property in the Credit Union as may be mine at the
time of my death, whether in share or otherwise.

Name _____________________________________________________________________

Address___________________________________________________________________

Telephone Number _________|___________ Relationship ______________________

EMPLOYMENT DETAILS

Company Name: ____________________Position held:_________________________

Work Address: _____________________________________________________________

_______________________________________________ Post Code: __ __ __ __  | __ __ __

Telephone/Ext Number: ________|____________ Payroll Number:____________

BANK DETAILS (We need these details from all members)

Name of Bank: ______________________  Branch _____________________________

Account Name(s):__________________________________________________________

Account Number: _________________________Sort Code: ____ - ____ - ____

(optional) Monthly amount of Standing Order _______ until further notice.

Signature:________________________ Date: ____/____/ 20___

Please supply proof of identity and address e.g. copy of Passport & Gas bill