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The West Indian Tobacco Credit Union and Consumer Co-Operative Limited

This document is a membership form for the West Indian Tobacco Credit Union and Consumer Co-operative Limited. It collects personal information such as name, date of birth, address, employment details, and financial information. It also asks the applicant to nominate a beneficiary to receive any benefits from the Society in the event of sickness or death. The applicant agrees to abide by the bylaws of the Society and pay a $10 entrance fee upon signing the form.

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adebo_yemi
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159 views

The West Indian Tobacco Credit Union and Consumer Co-Operative Limited

This document is a membership form for the West Indian Tobacco Credit Union and Consumer Co-operative Limited. It collects personal information such as name, date of birth, address, employment details, and financial information. It also asks the applicant to nominate a beneficiary to receive any benefits from the Society in the event of sickness or death. The applicant agrees to abide by the bylaws of the Society and pay a $10 entrance fee upon signing the form.

Uploaded by

adebo_yemi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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THE WEST INDIAN TOBACCO CREDIT UNION

AND CONSUMER CO-OPERATIVE LIMITED


MEMBERSHIP FORM

FOR NON MEMBERS

RELATIONSHIP TO WITCO EMPLOYEE / WITCU MEMBER __________________________________________

PERSONAL INFORMATION

NEW MEMBER’S NAME

__________________________ _________________________ _______________________


surname first name other name

I am an employee of _______________________________________________________________________________

Permanent Temporary Probation Contract Other _________________

DATE OF BIRTH: ____/____/____ SEX: MALE FEMALE


Day / Month/ Year

MARITAL STAUS: Single Married Divorce Widow Widower Common Law

Please provide two of the following I.D.Card # __________ Passport # _________ Driver’s Liscence # __________
MAILING ADDRESS ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
TELEPHONE NOS. _________________________ _________________________
HOME MOBILE
NATIONALITY _________________________________________
EMPLOYEE NO. (WITCO EMPLOYEES ONLY) _____________
DEPARTMENT ______________________________ OCCUPATION ____________________________

FINANCIAL INFORMATION
I enclose _________________________________________________________________ dollars ($______________)
RECIEPT # _______________________________ DATE PAID______________________________
I the undersigned, hereby apply for membership in the above society. I agree to abide by the bylaws and any subsequent
policies thereof. I also agree to pay an entrance fee of $10.00
PARTICULARS $
Entrance Fees $10.00
Shares
Deposit
Other
TOTAL

NOMINATION OF BENEFICIARY
In the event of sickness or death I nominate Mr/Ms/Mrs _____________________________________ my daughter/son/
father /mother/other(specify)___________________ of (address) ____________________________________________
____________________________________________________________________ to receive my benefits in the Society.
DATE OF APPLICATION __________________________________
PROPOSED BY_______________________________ SIGNATURE ___________________________________

OFFICIAL USE ONLY


APPROVED Not Approved
Chairman ____________________ Remarks _______________________ Account # _________________
Secretary ____________________ _______________________ Group # _________________
Date of Board _______________________ Date entered ________________
Meeting _____________________ _______________________ Initials __________________

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