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Adult Membership Application

Please fill out the form below to become a member of Leicester Credit Union.

Application for Membership

Forename(s)*

Surname*

Multi-line address

Country/Region

Address

City

Zip / Postal code

Tel.

Email

Date of Birth

Day

Month

Year

Occupation*

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

Provide details of previous Credit Union Membership(s)

Signed*

Date

Form of Nomination

I*

Of*

A member of Leicester Caribbean Credit Union Limited hereby nominate:

Next of Kin's name*

Of*

As the person to whom there shall be transferred upon my decease such property in the credit union as may be mine at the time of decease, whether in shares or otherwise.

Dated *

Day

Month

Year

Signature*

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