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Member Number
*
Name
*
Address
*
Date of Birth
*
Tel (mobile)
*
Tel (work)
E-mail Address
*
Account Purpose (Personal, Business or Club)
*
Personal
Business or Club
Occupation
*
Employment Status
*
Fulltime
Parttime
Source of Wealth (e.g., savings, gifts, inheritance)
Source of Funds (e.g., employment, gifts, inheritance)
*
How much are you planning on saving every month?
*
Country of Residency
*
Country of Birth
*
Nationality
*
Are you a Politically Exposed Person (PEP) as defined in Section 37 (10) of the Criminal Justice (Money Laundering and Terrorist Financing) Act, 2010?
*
Yes
No
Are you the beneficial owner of the funds in your shares/deposit account?
*
Yes
No
Would you like to sign up to E-Statements & the EAGM Booklet?
Yes
No
Help us go green and reduce our carbon footprint.
Would you like to sign up to our APP?
*
Yes
No
Would you be interested in volunteering with Thomastown Credit Union?
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Yes
No
Would you like to hear about loans available?
*
Yes
No
Do you consent to us contacting you by email?
*
Yes
No
I confirm the information I have provided in accurate
*
I confirm the information I have provided in accurate
I will promptly notify the Credit Union of any changes in the information which I have provided and confirm that I will inform the Credit Union in writing of the details of such changes and any other relevant/material information of which I may become aware at any time after the date of this Declaration.
*
I will promptly notify the Credit Union of any changes in the information which I have provided and confirm that I will inform the Credit Union in writing of the details of such changes and any other relevant/material information of which I may become aware at any time after the date of this Declaration.
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