Click here to return to the home page
Online Membership Application



Take control of your finances with a Credit Union Account.

* Indicates a mandatory field. You will NOT be able to submit your request if you fail to provide mandatory information.
SECTION 1 - PERSONAL INFORMATION
 
Title:
  if 'Other' please specify
Forename: * *
Middle Name(s):
Surname: * *
Address: * *
Post Code: * *
Home Telephone:
NI Number: * *
Email Address:
Date of Birth: *  /   /  *
Gender: * *
 
SECTION 2 - WORK DETAILS
 
Occupation Status:
  if 'Other' please specify
Nature of Business if Self Employed:
Name of Employer:
Employer's Address:
Post Code:
Work Contact Number:
Extension:
Payroll / Employee Number:
 
SECTION 3 - NOMINATION OF BENEFICIARIES
 
FIRST PERSON
Member No:
Title:
Forename:
Surname:
Address:
Postcode:
Home Telephone:
Mobile Telephone:
Relationship to you:
 
SECOND PERSON
Member No:
Title:
Forename:
Surname:
Address:
Postcode:
Home Telephone:
Mobile Telephone:
Relationship to you:
 
SECTION 4 - CONDITIONS & AUTHORISATION
 
a. I agree to maintain a minimum balance of £5.00 in my Share Account at all times.
b. I declare that the information given on this application is true and correct to the best of my knowledge.
c. I am also aware that my application is subject to approval by the Board of directors of the Credit Union.
(please tick to acknowledge that you agree to the stated 'conditions and authorisations' )
 
Ealing Credit Union is regulated under the Data Protection Act 1998. Any information you have provided on the form will be used internally. The information you have provided will not be disclosed to anyone without your consent.
 

We are delighted that you have decided to apply for membership of Ealing Credit Union using our on line membership application.  We shall create an account for you and send you the details.  Your application is subject to approval. In order to approve and activate your account we will require you to submit a copy of your documents as proof of identity and proof of address. This can be done either by post or email.


© 2011 Ealing Credit Union Limited


Powered by Kesho Systems    Secure Site