member application checklist

MEMBER APPLICATION CHECKLIST

Membership Application & Electronic Funds Transfer Agreement

Authorization for Payroll Deduction (2 copies)

In order to be in compliance with federal regulations for opening an account, all forms must be completed and the required documents attached prior to submitting this application to us for processing. Incomplete documents cannot be accepted. If you have any questions concerning this form, please feel free to call us at 774-1299. We look forward to serving you.

Documents needed:2 valid Picture ID's1 Proof of Physical Address (such as a current WAPA bill or 2 months rent receipt, or lease)

Social Security Card

Account Privacy Application

Please cut along this line

ACCOUNT PRIVACY APPLICATION

Effective May 1, 2017, St. Thomas Federal Credit Union implemented an internal control identifier on each members account. This identifier will be in the form of a "code word" and it is mandatory in order to conduct business by telephone regarding your account.

Name: Account #:

You will be required to provide us with this information when calling the Credit Union's office to conduct all business related to your account. For additional privacy and security of your account, once the information above is entered into our system, this form is immediately destroyed.

Code word guidelines: * not case sensitive *15 characters max *alpha numeric *special characters (ex. !@_#$%^&*)

For example: Code word: awesome1 Code Word:

C.U. Issued Member Number

MEMBERSHIP APPLICATION

MEMBER INFORMATION

Full legal name: Date of Birth:

Social Security No.: E-mail:

Mailing Address: Zip Code:

Physical Address:

Home Phone: Work Phone: Cell Phone:

Employer: Job Title: Employee #:

Are you related to an STFCU employee? No Yes If Yes, Name: Relationship:

Have you previously had an account with St. Thomas Federal Credit Union? Yes No

Do you belong to any branch of the military or reserves? Yes No If yes, which branch

ACCOUNT SERVICES OFFERED

I request the following services (CHECK ALL THAT APPLY):

Electronic Statements Internet Banking/Electronic Funds Transfer Telephone/Teller-By-Touch

Master Card Debit Card / Mother's Maiden Name: (for debit card security purposes only)

Deposits to be made by: Payroll Deduction Direct Deposit Check/Money Order Cash

MEMBERSHIP ELIGIBILITY

I am applying for membership through: (choose one)

My Employer/SEG A family member *(fill in below) Household Member

* Family/Household Member Name: Relationship:

MEMBERSHIP AGREEMENT

By signing below, I agree to the terms and conditions of the Membership and Account Agreement, Truth-in-Lending Savings Disclosure, Funds Availability Policy Disclosure, if applicable, and to any amendment the Credit Union makes from time to time which are incorporated herein. I acknowledge receipt of a copy of the agreements and disclosures applicable to the accounts and services requested herein. If an access card or EFT service is requested and provided, I agree to the terms of and acknowledge receipt of the Electronic Funds Transfers Agreement and Disclosure. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. (1) The number shown on this form is my correct identification number (or I am writing for a number to be issued), (2) I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to the backup withholding, and (3) I am a U.S. person (including a U.S. resident alien) Certification instructions: Cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. Cross out item 3 and complete a W-8 BEN if you are not a U.S. person.

Member Signature: Date:

VERIFICATION CHECKS

OFAC DATE OPENED: DATE CLOSED: DATE REJOINED:

EMPLOYEE:FOR STTFCU STAFF ONLY

BENEFICIARY DESIGNATION FORM

Change of Existing Beneficiary(ies) Designation

NAMING THE BENEFICIARY It is important that your beneficiary designation be clear so that there will be no question as to your intent. It is also important that you name a primary and contingent beneficiary. When naming your beneficiary(ies), please indicate their full name, address, social security number, and relationship. If the beneficiary is not related either by blood or marriage, insert the words, "Not Related." NOTE: If you are designating more than one beneficiary, total percentage should not exceed 100%.

Initial Beneficiary Designation

Additional Beneficiary Form

Member's Name:

Account #:

Mailing Address:

Social Security #:

Date of Birth:

Telephone No.:

Change of all prior beneficiary designation(s). I hereby revoke any previous beneficiary designation(s), if any, for my Share account(s) with St. Thomas Federal Credit Union.

REV. 7/2017

PRIMARY BENEFICIARY(IES):

CONTINGENT BENEFICIARY:

I, the undersigned, reserve the right to change the beneficiary(ies) at any given time without the consent of said beneficiary(ies).

Name: Social Security #:

Address:

Relationship:

Date of Birth:

Benefit Percent: %

%Benefit Percent:Relationship:

Date of Birth:Address:

Social Security #:Name:







Member's Signature: Date:




PAYROLL DEDUCTION AUTHORIZATION

Name: STTFCU Account #:

Employer/Dept.: Employee #:

Retiree only / SSS#: Date:

CHOOSE ONE OF THE FOLLOWING:NEW Deduct $ each pay period.

CHANGE Change my deduction from $ to $

STOP I wish to discontinue my deductions.

Member's Signature: STTFCU Representative:

I hereby authorize the Government of the Virgin islands, Government Employees' Retirement System, all other governmental & municipal entities whether of the federal state, local, or municipal government as well as any firm, company, partnership, individual or other type of private business establishment for which I may subsequently become employed to deduct the above stated amount from my salary each pay period until further notice from me in writing. The deduction is to be remitted to St. Thomas Federal Credit Union, P.O. Box 1138, St. Thomas, VI 00804 to liquidate my indebtedness to the Credit Union and said payments to continue until the debt is fully liquidated. I further authorize the deduction of any amount owed to St. Thomas Federal Credit Union from any accumulated earnings, club accounts, retroactive monies, retirement contributions, sick leave, severance pay, any bonuses, insurance benefits, earned unused vacation or annual leave monies in the event of termination or separation of any employment. Termination of this agreement unless written authorization is obtained from St. Thomas Federal Credit Union.

PAYROLL DEDUCTION AUTHORIZATION

Name: STTFCU Account #:

Employer/Dept.: Employee #:

Retiree only / SSS#: Date:

CHOOSE ONE OF THE FOLLOWING:NEW Deduct $ each pay period.

CHANGE Change my deduction from $ to $

STOP I wish to discontinue my deductions.

Member's Signature: STTFCU Representative:

I hereby authorize the Government of the Virgin islands, Government Employees' Retirement System, all other governmental & municipal entities whether of the federal state, local, or municipal government as well as any firm, company, partnership, individual or other type of private business establishment for which I may subsequently become employed to deduct the above stated amount from my salary each pay period until further notice from me in writing. The deduction is to be remitted to St. Thomas Federal Credit Union, P.O. Box 1138, St. Thomas, VI 00804 to liquidate my indebtedness to the Credit Union and said payments to continue until the debt is fully liquidated. I further authorize the deduction of any amount owed to St. Thomas Federal Credit Union from any accumulated earnings, club accounts, retroactive monies, retirement contributions, sick leave, severance pay, any bonuses, insurance benefits, earned unused vacation or annual leave monies in the event of termination or separation of any employment. Termination of this agreement unless written authorization is obtained from St. Thomas Federal Credit Union.