Clico Credit Union

Reformatted Membership Application

Documents for Application

Member Recommendation

Required only for prospective members outside the relation as per CCU Bye Laws, e.g. cousin, niece, partner, etc.

Identification

Employment

FATCA Compliance

Nominees

Criteria for Membership

Personal Information

Identification Information

Identification 1


Identification 2

Employment Information

Bank Details

Politically Exposed Persons

Politically Exposed Person (“PEP”) includes individuals such as the Head of State, Prime Minister, Head of Government, Government Minister, Parliamentary Secretary, Permanent Secretary, Senior Judicial Official, Senior Military Official, Senior Government Official, Chairman, Director, Commissioner or Chief Executive Officer of a state owned company, Commission or Regulatory Body, Member of the Tobago House of Assembly, Regional Corporation, Statutory Authority or a Senior Member of a political party or a senior politician and important political party officials who are or have been entrusted with prominent functions–, or a relative or known associate of that person.

If You have answered yes to any of the questions above, please complete the Additional Information Form

Foreign Account Tax Compliance Act (FATCA) Declaration

Documents required
If yes, copies of relevant passport(s) are to be provided and details given.

Documents required
W-9 or W-8BEN;
Document validating US citizenship;
Non-US passport or similar documentation establishing foreign citizenship

Documents required
W-9 or W-8BEN

Documents required
W-9 or W-8BEN

If yes, please list the Country/Countries of Residency for Tax Purposes, and corresponding Social Security Number (SSN) or Individual Tax Identification Number (ITIN) details.

Nomination Certificate

If the Beneficiary is a minor (under age 18) and does not have a valid form of Identification - Please provide original Birth Certificate.

General Information