Date of Birth

Surname

Forename(s)

Address

                                                                                          

                                                                                           Post Code

Home Tel                                                                            Mob Tel    

National Insurance No:

Have you been a member of this Credit Union before?    

Have you been a member of any other Credit Union before?   

Have you now or ever signed a Trust Deed or been Bankrupt?   

Name and Address of Employer

Proposed by                                                Membership No

Entrance fee £2, Paid into Shares £

Form of Nomination  (In case of death)

I                                                                   Address

A member of the above Credit Union hereby nominate:-

Name ____________________________    Address

As the person to whom there shall be transferred at my decease such property in the Credit Union as may be at the time of my decease, whether shares or otherwise.

Dated______________

Any Special Instructions

Signature_________________________________

Must not be person nominated

Witness__________________________________ Witness_____________________________________________

Address _____________________________________________________________________________________

              

             _____________________________________________________________________________________

Print

APPLICATION FORM FOR MEMBERSHIP

COMPLETE BOTH SIDES IN BLACK INK

VALE OF LEVEN CREDIT UNION

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____________________________________________________

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__________

___________________

_______________

______________________________________________________________________

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YES/NO

YES/NO

YES/NO

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__________________

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