Becoming a Member Form

1 - Submission of documents

2 - Personal information

3 - Employment Information

4 - Beneficiary Details

5 - PEP

6 - Declaration

7 - Youth Membership

DOCUMENTS CHECKLIST

(PLEASE PROVIDE ORIGINAL DOCUMENTS)

1st form of Valid identification (National ID, Drivers Permit, Passport) *

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2nd form of Valid identification (National ID, Drivers Permit, Passport) *

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Proof of Address must carry applicant's name (Utility Bill or Internet or Bank Statement in Absence of Utility Bill) *

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(N.B.) If the utility bill is not on the applicant's name, written consent and valid identification are required from the the bill owner to use the bill)

Beneficiary's Valid Identification(i.e. National Identification Card, Drivers Permit or Passport) *

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Select an option below to upload the required files *

Employed Self-Employed Unemployed

Proof of Employment - Job Letter (within 3 months) *

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Proof of income - Pay slip (within 1 month) *

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Self-Employed - Business Registration and other Statutory Documents Required *

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Unemployed Persons - Evidence to support how the account will be funded *

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Applicable to foreigners/ non - residents only -A reference letter is required as confirmation/evidence of prospective member's relationship with their foreign bank (legal requirement)

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NOTE:
You are required to submit all original documents and a passport size photo when you visit the branch

PERSONAL INFORMATION

Title

Gender *

Surname *

First Name *

Other Name / Middle Name

Verification

Utility Bill Bank Statement Other - Must be Member's and within 3 months

Residential Address *

Postal / Mailing Address

Date Of Birth *

Place Of Birth

Nationality

National Non National

Indicate Your Nationality

Country Of Residence *

Home Telephone

Work Telephone

Cell / Mobile Telephone *

Fax Number

Email Address *

Marital Status *

Single Married Separated Divorced Widowed Common Law Other

Next Of Kin Name

Relationship

Telephone Number

ID *

Country Of Issuance

Expiry Date *

Country Of Issuance

Expiry Date

Country Of Issuance

Expiry Date

BIR File Number / TAX Number

Birth Certificate Pin

NIS Number

EMPLOYMENT INFORMATION

(Adult applicant or Parent/Guardian of youth applicant)

OCCUPATION INFORMATION

Employer Name *

Employee Number *

Work Address *

Position / Occupation

Salary

Pay Period

Monthly Forthnightly Weekly

Period Of Employment

Job Position

Contract Full time

Date Of Employment

Telephone Number *

SELF EMPLOYED

If Self-Employed or with side job please complete:

Occupation *

Name Of Business

Business Address

Business Telephone Number

VAT Registration Number (if applicable)

Certificate of Incorporation (if applicable)

Copy Attached

Yes No

Gross Annual Income Details *

< $50,000 $50 ,000 - $100 ,000 $100 ,000 - $200 ,000 $200,000 - $400,000 >$400,000

GENERAL INFORMATION

Why do you want to be a member?

Were you previously a member of this credit union? If yes, state reason for resigning.

Yes No

Were you expelled? If yes, state reason:

Yes No

Are you related to any Member Officer of the credit union? If yes, give name and relationship

Yes No

BENEFICIARY INFORMATION

I hereby nominate the undermentioned to receive my interest and benefits in the event of my death or disability.

Title *

Surname *

First Name *

Other Name / Middle Name

Residential Address *

Postal / Mailing Address

Relationship *

Date of Birth *

Place of Birth

Home Telephone

Work Telephone

Cell / Mobile Telephone *

ID *

Country of Issuance

Expiry Date

Country of Issuance

Expiry Date

PP *

Country of Issuance

PEP

Yes No

Expiry Date

BIR File Number / TAX Number

Birth Certificate Pin

NIS Number

POLITICALLY EXPOSED PERSONS (PEP)

PURSUANT TO REGULATION 20 FOR THE FINANCIAL OBLIGATIONS THE FOLLOWING QUESTIONS MUST BE ANSWERED

Please tick if you fall into any of these categories:

Are you an INDIVIDUAL, in Trinidad and Tobago or a Foreign Country or a Close Personal/ Professional Associate of:

A) Head of State *

Yes No

B) Government*

Yes No

C) Senior Politicians*

Parliament Members (national, local or THA election), Senators, Appointed to serve in the THA under the THA Act, Alderman in a Municipality or Regional Corporation under the Municipal Corporations Act.

Yes No

D) Senior Government Official*

Parliment Secretary, Accounting Officer under the Exchequer & Audit Act, or holding equivalent positions in a foreign country.

Yes No

E) Senior Judicial Offical*

Cheif Justice, Judges of the Supreme Court (Appeal & High Court Judges) Masters of the Supreme Court, Industrial Court Judges, Caribbean Court of Justice Judges, The Registrar, Deputy Registrar, Assistant Registrar, Cheif Magistrate Deputy Cheif Magistrates and Magistrates of the Magistracy

Yes No

F) Senior Military Offical*

E.g. Defence Force - Major General, Brigadier General, Colonel, Lieutenant Colonel. Air Guard - Group Captiain, Wing Commander, Squadron Leaders, Coast Guard - Rear Admiral, Commodore, Captain, Commander, Commanding Officer of the Air Guard and Defence Force

Yes No

G) Senior Executive of State-owned Corporations*

Chairman, Deputy Chairman, President or Vice President, of the BOD, Managing Director, General Manager, Comptroller, Secretary, Treasurer or any other person who is duly appointed to perform functions similar to those normally performed by the holder of any office specified.

Yes No

H) Important, Political Party Official*

Chairman, Deputy Chairman, Treasurer of a Political Party registered under the Representation of the People Act or Individuals holding equivalent positions in foreign country.

Yes No

I) Persons who are or have been entrusted with a prominent function by an international the organisation which refers to members of senior management*

Such as directors and members of the board or equivalent functions; (UN, OAS, IADB , ILO, CFATF)

Yes No

J) Immediate Family Member of individuals described above*

Spouse, Parents, Siblings, Children & children of the Spouse of that person.

Yes No

K) Are you publicly known or actually known to the relevant financial institution to be a close a personal or professional associate of the persons referred to in any of the above.*

Yes No

If you have answered YES to any of the above please provide detail

DECLARATION

I hereby declare that the above information is true and correct to the best of my knoweledge, and i shall immediately inform PSCU Credit Union of any change in such information. I authorize PSCU Credit Union to verify any or all information provided. I hereby promise to abide by the rules and regulations made and to be made of the Credit Union. I agree to indemnify the Society against any loss, claims damages liabilities or actions and legal proceedings and or other expense which may be directly or indirectly incurred as a consequence of incorrect or misleading information given by me. In addition, I/We also give PSCU Credit Union Co-operative Society Ltd, permission to obtain any credit report on my financial position from time to time throughout the duration of any loans being held with the organization.

Applicant Name *

Date

Witness Name

Witness Address *

Witness Occupation

Date

Recommender

Type your name below

having reasonable knowledge of the applicant, recommend him/her for membership in PSCU Credit Union Co-operative Society Limited.

Please visit the branch to sign your application, and to submit a passport size photo along with all original documents.

Recommender Name *

Account Number of Recommender

Relationship

YOUTH MEMBERSHIP

This section is for parent(s) or guardian(s) of youth applicants under 18 years of age ONLY.

(1) PERSONAL DATA OF PARENT / GUARDIAN

Surname

First Name

Residential Address

Mailing Address (If different)

ID Card Number

Cell / Mobile Telephone

Passport Number

Driver's Permit Number

Email Address

Relation to Applicant:

(2) PERSONAL DATA OF PARENT / GUARDIAN

Surname

First Name

Residential Address

Mailing Address of Guardian (If different)

ID Card Number

Cell / Mobile Telephone

Passport Number

Driver's Permit Number

Email Address

Relation to Applicant:

Are you a member of PSCU Credit Union Co-operative Society Limited?

Yes No

If selected NO, Parent/Legal guardian will have to join/become a member in order to join the child

This section is for applicants under 18 years of age ONLY

Applicant Full Name

Name of educational institution attending:

DOCUMENTS CHECKLIST

PERSONAL INFORMATION

EMPLOYMENT INFORMATION

OCCUPATION INFORMATION

SELF EMPLOYED

GENERAL INFORMATION

BENEFICIARY INFORMATION

POLITICALLY EXPOSED PERSONS (PEP)

DECLARATION

Recommender

YOUTH MEMBERSHIP

(1) PERSONAL DATA OF PARENT / GUARDIAN

(2) PERSONAL DATA OF PARENT / GUARDIAN

This section is for applicants under 18 years of age ONLY

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