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