Online Application Form

Gender: *

Your Name: *

Residential Address: *

Mailing Address:

Date of Birth: *

Place of Birth: *

Nationality: *

Trinidad and Tobago National U.S. Resident Other (Please state)

Home Phone *

Work Phone

Cell Phone *

Email Address: *

Would you like to receive email notifications of SECU Credit Union’s products and services: *

Yes No

Identification Information (Only Two (2) valid forms):

DP / PID / PP Number: *

Country of Issue: *

Issue Date: *

Expiry Date: *

DP / PID / PP Number:

Country of Issue:

Issue Date:

Expiry Date:

If one of the above is not provided:

Birth Certificate Pin No:

Country of Issue:

Employer: *

Work Address: *

Occupation: *

Rank/Position: *

TTDF Reg # (TTDF only):

Name of Bank:

Bank Account:

Recommender’s Name to SECU:

Relation to Recommender:

Are you a bona fide member of any other credit union?

Yes No

If yes, please name the credit union:

Politically Exposed Person (“PEP”) includes individuals such as the Head of State or Government, senior politician , senior government, judicial or military officials, senior executives of State-own ed corporations and important political party officials who are or have been entrusted with prominent functions –, or a relative or known associate of that person.

Are you a PEP?

Yes No

Are you related to a PEP or any person that holds a High Position in Public Office:

Yes No

If yes, Please state relationship:

PEP

1. Political Party Official 2. Senior Executive of a State Enterprise 3. Minister of Government 4. Diplomat 5. Member of judiciary 6. Senior Official employed at a Public Authority 7. Occupy a senior role/position with the military services

In the event of death, I hereby nominate of to receive a sum not exceeding $50,000.00 in accordance with section 10(e) of Bye Laws of the Society.

Relation to Member:

Email Address:

Beneficiary ID #

Telephone:

I, , I hereby apply for membership of and agree to abide by the laws of the SECU Credit Union and declare that this information given by me on this form is true and correct to the best of my knowledge.

I agree to provide proof of identity and address to satisfy Government Anti-Money Laundering/Combatting the Finance of Terrorism (AMI/CFT) laws.

By submitting this application form you will be indicating your consent to receiving product and service information by letter, Telephone or email from us. (Do not click if there is an objection).

In accordance with the principles of Data Protection Act 2011, we will use your personal details for the purposes of managing your accounts with SECU credit union. Your personal details will be treated confidentially and will only be shared with agencies for the purpose of credit referencing, debt recovery and statutory and legal requirements only.

Your Name:

Witness Name:

This field is optional