APPLICATION FOR MEMBERSHIP ST ALBANS DISTRICT CREDIT UNION

I apply for membership of the St Albans District Credit Union and agree to abide by its rules. I declare that information given by me on this form is true to the best of my knowledge. Please tick to show which of the following three qualifications makes you eligible for joining the Credit Union. Please note the Proof of Identity requirements at Section 4

To be eligible for membership you must answer YES to one of the following questions Do you live in the local government area of the City & District of St Albans?
Complete Section 1 (and Section 3 if applicable) Yes

Is your Spouse/Partner already a member of St Albans District Credit Union?

Complete Section 1 only

Yes

Do you work in the local government area of the City and District of St Albans? Complete Sections 1 , 2 (and Section 3 if applicable)
Section 1. Applicant

Yes

Surname Forenames Address Mr, Mrs etc

Post Code

NI Number

Land Line

Mobile

Email

I have lived at the above address for

Or

Years

Months

I am the spouse/partner of a member (please give name, address and membership number of member)

Membership Number

I have worked for my present employer for

Years

Months

Appllicants Signature .........................................................

Date....................

Section 2: To be filled in by applicants who work in the local government area of city and district of St Albans but do not reside there.

Occupation Employer's Name Employer's Address

Work Reference (eg: payroll number if known)

Section 3: Permanent address (if different from that given in Section 1 or 2)

Address

Section 4: Proof of identity. Documents to be provided by applicants

Please provide a total of 3 (THREE) items from the list below to prove identity upon application to be a member. A check will be made to ensure that the doc uments are current. At least one item should be from each list. If arranging payroll deductions, proof of identity and residence can be provided by your employer, if you complete and sign the Payroll Deduction Form (Form M6) available from the Credit Union office at 135 Hatfield Road List A: to confirm who you are (ID) and address List B: to confirm your name Council tax bill* Utilities bill* Bank statement* Rent book (or account)* Medical card. Pension book** Benefits book** Driving licence.

Birth Certificate National Insurance card Valid passport Driving licence** Marriage certificate Employers ID with photograph. Personal cheque Pension book** Benefits book**
* Should be less than 3 months old

** Cannot be used for both ID and to confirm name and address Bring or post completed form and supporting documents to: St Albans District Credit Union, 135 Hatfield Road, St Albans, AL3 5JX

Or hand to CU representative at a St Albans District Credit Union Collection Point. Documents will be returned after verification and photocopying
-----------------------------------------------------------------------------------------------------FOR OFFICE USE C ollection Point .................. Officer.................

ID Checked Identity Membership Paid Payroll Deduction

Y/N Y/N Y/N Y/N

Residential Other Initial Share allocation paid Standing Order

Y/N Y/N Y/N Y/N

Application approved by ........................................... ...Member of Board of Directors

Signature .................................................. Date...............................