Membership Application Form

A: MANDATORY CHECKLIST

• Valid Identification (National ID, Passport, Driver's License)
• Tax Registration Number (TRN)
• Name & Address of References
• Proof of Address (Utilities Bills, Bank Statement, Lease/Rent Agreement or Post Marked Envelope
• Proof of qualification for membership

* Account type

B: ABOUT YOU

* Surname

* First Name

Middle Name

* Title

Maiden Name

Alias

* Date of Birth (DD/MM/YY)

* Gender

* Status

# Of Dependents

# Of Children(s)

# of Minors

* T.R.N. of Applicant

* Type of Identification

* Identification #

* ID Expiry Date

Proof of ID

Proof of Address

Birth Certificate

* Place of Birth

* Country of Residence

* Nationality

* US citizen or holder of a green card?

* Citizen apart from Jamaica and the US?

* Which Country?

* Current Home Address

* Parish

* Home Status

* Years There

Previous Home Address:

Parish

Home Status

Years There

Mailing Address

Email Address (Work)

* Email Address

Home Telephone #

Work Telephone #

* Mobile Telephone #

Fax Telephone #

Surname of Spouse

Firstname of Spouse

Spouse Contact Number

* Emergency Contact Name

* Emergency Contact Phone

* Highest Level of Education

* Are you a politically exposed person?

If yes state the name of the office held

* Are you related to a politically exposed person?

If yes state the name of the individual and the office held

* Are you related to an employee(s) or volunteer(s) of Grace Credit Union?

C: INCOME & EMPLOYMENT INFO

* Name of Employer/Business/School

* Occupation/Job Title

* Job Status

Address of Employer/Business/School

Telephone #

Which of the following come closest to your monthly income?

Date Employed/Attending School

D: PROJECTED LEVEL OF ACTIVITY

* What is your projected level of activity

* Opening Deposit Amount

* Source of Funds

E: MARKETING

* We would like to keep you up to date with information on our products and services.
To do this, we would like to contact you by telephone, post, email or SMS

2. Source of referral:

Name of Source Referral

F: UPDATING AMOUNT

In keeping with Section 46 of the BOJ Guidance Notes the personal information of all accounts maintained at the Credit Union must be updated every five (5) years from the date of commencement of relationship.

G: APPLICANT'S DECLARATION

I hereby apply for membership in this Credit Union and declare that the information provided on this application is true and agree to notify the Credit Union of any material change thereto. I authorize the Credit Union to obtain any information it may require, relating to this application from any source it deems relevant and I agree to conform to the Rules and amendments thereof, and subscribe to a minimum of $1,000.00 in Permanent Shares and a minimum of $600 in Voluntary Shares at a nominal value of one (1) Jamaican dollar each.

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