Applications

DENNERY COMMUNITY CREDIT CO-OPERATIVE SOCIETY LIMITED

APPLICATION FORM FOR MINOR

Date of Application

Time

Account #

Name

First Middle Last (alias)

Date Of Birth

Home Tel #
Format: 1758-555-5555

Gender

MaleFemale

Country Of Birth

Passport #

Home Address

School

Grade

I agree to conform to the by-laws of the Credit Union and the Co=operative Societies Act

Only parents or guardians named in this application are eligible to make withdrawals on behalf of the minor.

Instructions for withdrawal:

Either Parent can signOther

Other, please specify

Name of person opening account

Relationship

Address

Telephone
Format: 1758-555-5555

NIC #

ID Card #

Occupation

Employer

Marital Status

MarriedSingleCommon Law

Work Address

________________________
Signature of Applicant

________________________
Child's Signature

Other Person(s) transacting on behalf of minor (if different from person opening account)

Name

Address

Occupation

Employer

Work Address

Date of Birth

NIC #

ID Card #

Passport #

Telephone #
Format: 1758-555-5555

Marital Status:

SingleMarriedCommon Law

________________________
Signature of authorized person

Name

Address

Occupation

Employer

Work Address

Date of Birth

NIC #

ID Card #

Passport #

Telephone #
Format: 1758-555-5555

Marital Status:

SingleMarriedCommon Law

________________________
Signature of authorized person

________________________
Witness

membership

Other Services

Dennery Community Credit Co-operative Society Ltd.
Victoria Street
Dennery
Saint Lucia

Phone: 1-758-453-4189
Fax:
Email Address: info@dennerycreditunion.com

Business Hours
Monday - Friday
8:30 am - 4:30 pm

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