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RENCAM ASSOCIATION & CREDIT UNION Membership Application Form – Adult Persons

Please use this form for application for RENCAM Association and Credit Union Adult membership. Please tick one of the following:

A. PLEASE COMPLETE THIS FORM IN CAPITAL LETTERS
Title:
A1.If select Other, complete field
Last Name:
First Name:
Current Address:
City/Town:
Post Code:
Home Tel:
Mobile
Email Address:

How long have you lived at this address:

Years:
Months:

(If less than 3 years please provide addresses you have lived at for the past 3 years)

Previous Address:Please provide your first previous address
0 /
Previous Address:Please provide your second previous address
0 /
Previous Address:Please provide your third previous address
0 /
Date of birth(dd/mm/yyyy)
National Insurance Number
B. Employment Status
Occupation:Your current job title or role
C. Next of Kin (Beneficiary)
I designate:
Relationship:
Tel No:
Address:
City/Town:
Post Code:

As my beneficiary, to receive any money due under the Life Insurance Terms and Savings Plan of the credit union or Njangi provided I have fulfilled the agreement of any outstanding loans. I reserve the right to change the beneficiary.

D. Bank Details (needed for transactions with the Credit Union)
Name of Bank/Building Society:
Account Holder Name:
Account Number:
Sort Code:Format (00-00-00)

How did you hear about us?

If other was selected
G. DECLARATION

I, the Undersigned:

  • Confirm that the information given above is true and complete to the best of my knowledge
  • Authorise any enquiries RENCAM Credit Union may deem necessary in conjunction with this application.
  • Understand that my personal information on this form together with other information collected and held by RENCAM Credit Union may be stored on paper or electronically
  • Have been advised that all information is held in accordance with the Data Protection Act 1998, and is held in the strictest confidence.
  • Authorise you to open a membership savings account in my name, and debit the annual membership fee from it
  • Understand that any information supplied by me that is subsequently found to be false may lead to summary termination of my membership of RENCAM and the Credit Union
Signed:Enter your fullnames
Date(dd/mm/yyyy)
Important DocumentsPlease upload 1) ID and 2) Proof of Address documents
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