Antilles Credit Union - Membership Update

We are currently in the process of updating our membership records. Kindly take a few moments to complete this short survey. All of your information will remain confidential. Kindly upload the following documents at the appropriate fields: - Two (2) forms of ID (any combination of your ID Card, Driver's Permit and Passport. Your Birth Certificate may be submitted if you only have one form of ID) - A recent Utility Bill in your name (or with an attached Authorisation letter, if Bill is not in your name) - A recent payslip (as per last paid) or a job letter (no older than one month). Please liaise with the Credit Union if you are self-employed or unemployed. We thank you for your cooperation!

Account Number

First Name

Surname

Gender

Address

Please attach recent Utility Bill if available

Attach file

Drop files here

Please attach authorisation form (if bill is not in your name)

Attach file

Drop files here

Please attach bill holder's ID (if bill is not in your name)

Attach file

Drop files here

Email Address

Telephone Number 1

Telephone Number 2

Date of Birth (dd/mm/yyyy)

Marital Status

If Male and married: Wife's Maiden Name

If Female and married: Husband's Full Name

Select your ID type #1

ID Type #1 Number

Please upload ID Type 1 if available

Attach file

Drop files here

Select your ID type #2

ID Type #2 Number

Please upload ID Type 2 if available

Attach file

Drop files here

Are you a politically exposed person?

Highest Completed Level of Education

Employment Status

Name of Employer/Business

Occupation

Employer/Business Address

Please upload copies of your Business Registration documents (self-employed persons only)

Attach file

Drop files here

Pay Frequency

Average Monthly Income

Would you be interested in serving on the Board or any of the Committees of the Credit Union?

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