Tel: 0151 258 1014 Email: enquiries@partnerscreditunion.co.uk

23 July 2017
Online Membership Form

Please complete all your details in the form below, and click submit when you have finished.

Membership Application Form
* Required Fields
To become a member of Partners Credit Union, simply fill in this online Application Form. There is a one-off joining fee of £5 which will be taken from your first deposit.
All applicants should complete ALL sections
If you would like to pay by Standing Order please fill in Section 2 (Instruction to your Bank). Partners Credit Union will forward this to your bank once you have joined.
If you would like to pay in from your wages, and your employer has agreed to take part in our Payroll Deduction Scheme, please fill in Section 3 (Payroll Deduction Order). Partners Credit Union will forward this to your employer once you have joined.
If you have any questions about filling in this form, please use the details above to contact one of our offices for help or advice.
Identification Required when you join - please read this section carefully
We are legally required to verify the identity of all new members. In order to verify the information you provide we may make searches about you with a credit reference or Fraud Prevention Agency; this will include information from the Electoral Roll. The agencies will record the details of the search whether or not your application proceeds. Other lenders may share these searches in order to prevent fraud. Any documents provided to us will be recorded and copied for audit purposes as part of our Anti Money Laundering requirements.
We will do an electronic verification however if we are experiencing difficulty then we will contact you for further information and documents.
Section 1
* Required Fields
Application Form all applicants should fill in EVERY section, if not your form will be returned
Title: *
Forename(s): *
Surname: *
Current Address: *
Postcode: *
How long have you lived here?: *
Status: *
If Other, please explain:
If Rented please provide your Landlord/Housing Association details below
Landlord Name:
Address:
Previous address if less than 3 years:
Home Telephone:
Mobile Telephone:
E-Mail Address: *
Date of birth: *
National Insurance No: *
Section 2
* Required Fields
Other Details – required for membership criteria (if Retired or Unemployed just write RETIRED/UNEMPLOYED)
Are you a Trade Union member (Including Spirit of Shankly): *
If YES, which one?:
Name of Employer:
Workplace address:
Postcode:
Section 3
* Required Fields
Next of Kin Details - who would you like your savings to go to in the event of your death
Full name: *
Relationship to you: *
Their Address: *
Postcode: *
Contact No: *
Section 4
* Required Fields
Saving Amounts & Other Commitments. Please indicate how much you want to save and how frequently
How will you be making your payments into the Credit Union?: *
If other please explain:
If Benefit Payment - which one & what is your reference no:
Frequency/How Often will it be paid:
Amount which will be paid to us:
Section 5, Payroll Deduction Order
* Required Fields
Fill in this section if you would like to have your payments taken directly from your wages.
I hereby authorise the Payroll Provider (if required) to deduct (the new total) per week/month from my wages/salary in favour of Partners Credit Union Ltd. I agree to deductions commencing from the first available pay date and to remain in effect until such time as I give notice, in writing, of any change.
New Total:
Employer:
Address / Place of work:
Your full name:
Payroll number:
Department:
Credit Union membership number:
Signed:
Date:
Section 6, Additional Information
* Required Fields
This information will help us to improve our services and reach more people across Merseyside
1: Promotions: From time to time, we take part in special promotions, for example the Helena Housing promotion. If you are joining as part of a special promotion, please let us know so that we can enter you into it. Please tell us about the promotion here::
2: Where did you hear about us?: *
If event, please specify which one:
If local press, please specify which paper/TV/Radio:
Other:
3. Which advantage most encouraged you to join? (please tick those that apply): *Convenient Savings
Affordable Loans
Ethical Services
Free Life Insurance on savings & loans
Safe savings
Not-for-profit
PayPoint Card
Friendly Service
Democratic Structure
Online Access
Free Life Insurance on savings & loans
Other
If other please specify:
4. How long did it take you to join? Did you….: *
5. Any comments?:
Name: *
Date: *
Postcode: *
Section 7, Standing Order Form
* Required Fields
Instruction to your bank. If you wish to pay in by Standing Order from your bank, please complete this section and return it to Partners along with the rest of your application form.
Your Details
* Required Fields
Your Full Name:
Contact telephone number:
Your bank branch name:
Your bank account Sort Code:
Your bank Account Number:
Standing Order Details
Does this instruction replace any existing standing order or direct debit instruction?:
How often do you want the payment made?:
Recipients name: Partners Credit Union
Recipients Bank & Branch name:
NatWest, St Helens Branch,
5 Ormskirk Street,
St Helens Merseyside,
WA10 1DR
Recipients Sort Code: 60 - 70 - 08
Recipients Account Number: 51121247
First Payment Date:
Payment Amount In Words:
Payment reference (Member no. and name:
Your agreement with us. This request is addressed to the bank which holds my / our account.
I authorise you to debit my / our account, in accordance with the details in Section 2.
Your signature:
Date:
Your Savings Payments
* Required Fields
Regular Savings Amount: *
How often: *
Christmas Club Amount: *
How often: *
Lottery (£1 per month)
* Required Fields
(£1 per month per ticket – you can have up to 10): *
How Many?:
Declaration & Agreement
* Required Fields
I hereby apply for membership of Partners Credit Union and agree to abide by the terms/conditions/rules, regulations, procedures and policies of Partners Credit Union. I declare that the information given by me on this form is true and correct to the best of my knowledge and belief. I understand that the provision of false information is fraud and that the Credit Union may take appropriate action if I am found to have deliberately provided false or misleading information. We will not sell/pass on any of your details to any third parties however from time to time we may wish to contact you, the account holder about other PCU products or services which we think may be of interest to you.
If you want to receive information of this nature, please indicate: *
Signature: *
Date: *
Please enter the code shown:
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Partners Credit Union Limited Tel: 0151 258 1014 Email: enquiries@partnerscreditunion.co.uk Web: http://www.partnerscreditunion.co.uk