Willowfield CU | Willowfield Credit Union Limited Membership Application Form

WILLOWFIELD CREDIT UNION LTD

37-41 Cregagh Road Belfast, BT6 8PX

Phone: 028 90455415 E-Mail: info@willowfieldcreditunion.co.uk

Please complete the form below

PERSONAL DETAILS

Title *

First Name *

Surname *

Date of Birth *

Telephone Number

Mobile Number

Email *

Gender *

I confirm that the account is for my own personal use and benefit *

Occupation (maximum 24 characters)

Current address

House Number or Name *

Address Line 1 *

Address Line 2

Town

County

Postcode *

Country *

PEP's Declaration

Please read the following before answering the questions below

Politically Exposed Person (PEP) is defined under regulation 35 (14) of the Money Laundering, Terror Financing and Transfer of Funds (Information on the Payer) Regulations 2017 as an individual who is entrusted with a prominent political function, other than as a middle ranking or more junior official e.g Heads of State or of Government, ministers (including deputy or assistants), members of parliament or devolved legislative bodies including the Northern Ireland Assembly, senior government, judicial or military officials, senior executives of state owned corporations or international organisations and members of the governing bodies of polital parties.
Please also declare if you are a family member (spouse or civil partner of the PEP's children; parents of the PEP) or close associate of a PEP. If you are uncertain as to your sttus please discuss this with the credit union.
This information is requested for the purpose of compliance with the credit union's obligations under anti money laundering and terrorist financing legislation.

Are you a Politically Exposed Person? *

Are you related to, or a close associate of a Politically Exposed Person? *

Beneficiary

Please provide details of a beneficiary. A beneficiary is someone that would inherit your savings with the credit union in the unfortunate event of your death.

Beneficiary First Name *

Beneficiary Surname

First line of address

Nominee Address Line 2

Nominee Address Town

Beneficiary Contact Number

What is your relationship to the Beneficiary?

Supporting documentation

To verify your application please provide the following supporting documentation using the upload facility below
Photographic ID such as driving license, passport
Proof of Address such as recent bank statement, utility bill, councl tax documentation
Any other documentation to assist your ID
These should be uploaded below by either a photo (jpeg) or pdf document

Photo ID *

Proof of address *

Other supporting evidence

death benefit rider (DBR)

In addition to loan protection/life savings insurance the special Death Benefit Rider, designed to relieve the burden of bereavement costs, is deducted each year (conditions apply).

Recent market research indicates a demand among credit union members for this service.

There is a trend towards under-insurance in Ireland. In addition to this, the cost of funerals has soared in recent years, ranging from £1,000 to over £4,000 and is especially high in urban areas. Very few people realise the impact of funeral expenses on any life assurance benefit they have.

The addition of the Death Benefit Rider (DBR) to the Life Savings Policy will give family members added security and relief from financial worry at the time of the death of a member.

Premium Cover: £2,000
This is a very high value-for-money scheme and ensures that your family had added support when it is needed most.

Premium Cost:
This is a variable annual amount payable by the member as part of annual remuneration (dividend less variable premium).

This does not apply to members who join after 70 years of age

I understand that the DBR will be deducted annually *

Declaration

Important Your Personal Information: Credit decisions and also the prevention of fraud and money laundering.

We may use credit reference and fraud prevention agencies to help us make decisions. What we do and how both we and credit reference and fraud prevention agencies will use your information is detailed in Our privacy notice

I accept the use of Credit Reference Agencies and declare that the information given by me on this form is true and correct, to the best of my belief. *

In making this application I apply for membership of Willowfield Credit Union Ltd and agree to abide by the rules. *

I confirm I have read the FSCS information and understand how my deposits are protected. *

Would you like to receive marketing information specifically from Willowfield Credit Union *

To complete your application please ensure your Email address is correct and then select Apply below.