Clico Credit Union

Source of Funds Declaration Form

Source of Funds Declaration Form

Member Information

Depositor Information

If different from Member

Transaction Details

Declaration of Source of Funds

Check all that apply
Personal Savings
Sale of Vehicle
Proceeds from Investment
Employment Bonus
Sale of Property/Real Estate
Sale of Shares/Dividend
Insurance Setllement
Proceeds from Self-owned Business
Other (state below)