Sheffield Credit Union

Application for membership

Please print off this form, complete all sections and bring / send it to:

Sheffield Credit Union, Unit 6 North Gallery, Exchange Street, Sheffield, S2 5TR

Title: _______  Forenames: __________________________   Surname: ___________________

Address: ______________________________________________________________________

______________________________________________________________________________

Post Code _________   

Telephone _________________

Date of Birth _______________

National Insurance number _______________

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Form of nomination

In the event of my death I nominate the following person(s) to whom there shall be transferred such property in the Sheffield Credit Union as is mine at the time of death, whether in shares or otherwise.

Nominee Name(s) _______________________________

Address _______________________________

______________________________________

______________________________________

Witnessed by (Name)

Witness signature

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Declaration: I hereby apply for membership and agree to abide by the rules of Sheffield Credit Union and declare that the information given is correct to the best of my knowledge.

Signed ________________

Date ________________

Authorised and regulated by the Financial Services Authority 213679                                                 Produced 23/6/05