Just follow the steps below to apply for an E&G EFCU
membership.
1. Complete the Membership Application below (be sure
to read and complete all the sections).
2. Sign-up by mail or in person. If you mail your application,
your signature(s) must be notarized.
3. Mail check or money order for $30.00 to cover your
initial minimum deposit of $25.00 to open your Share Savings
Account and your non-refundable $5 membership fee. Make check
payable to E&G EFCU. If you sign-up in person, cash may
be used.
4. Attach copy of photo identification.
Name
_____________________________________
Type of I.D.
_____________________________________
I.D. No
_____________________________________
Complete Address
_____________________________________
Husband's first or Wife's maiden name
_____________________________________
Employer
_____________________________________
Business #
_____________________________________
Home #
_____________________________________
Dept. or Occupation
_____________________________________
Place of Birth
_____________________________________
Date of Birth
_____________________________________
Mother's maiden name
_____________________________________
Membership Eligibility
_____________________________________
Social Security # or
Tax I.D. #
_____________________________________
By signing below, I hereby make application
for membership in agreement to conform to the bylaws and
any amendments thereof in the Educational & Governmental
Employees Federal Credit Union.
I also agree to the terms and conditions of any account
that I have in the credit union now or in the future and
agree that the credit union may change those terms and
conditions from time to time.
To be completed by Credit Union
Account Number
_____________________________________
Date
_____________________________________
Signed (Person representing, approval of
application)
_____________________________________
INSURANCE BENEFICIARY DESIGNATION
If life savings insurance is carried in connection
with this account, I, the account owner who is insured,
hereby agree that any amounts payable to anyone or added
to this account by reason of such insurance shall be
paid to
Name
_____________________________________
Relation To Member
_____________________________________
Address
_____________________________________
if then living whom I hereby designate beneficiary
of such insurance. I reserve the right to change or
terminate the designation of beneficiary. I further
agree that any designation or change of beneficiary,
or termination of designation, shall be binding upon
the credit union only if filed with the credit union
prior to my death on a form supplied by the credit union.
In the absence of the filing of such a designation,
change or termination, I agree on behalf of myself and
my heirs, assigns, personal representatives and all
other persons claiming through me to indemnify and save
the credit union harmless from all loss or damage by
reason of the payment of the proceeds of such insurance
to the beneficiary named above. I understand that the
credit union has no obligation to continue to provide
life savings insurance and that whenever the credit
union does provide such insurance, it may, in its sole
discretion, cancel the insurance at any time.
Account owner who is insured: (signature)
_____________________________________
Dated
_____________________________________
Insurance Carrier
_____________________________________
Contact No.
_____________________________________
Consent of Spouse
(to be completed in community property states
if designated beneficiary is someone other than spouse
of insured)
Approved and consented to: (signature of
spouse)
_____________________________________
ACCOUNT DESIGNATION
Payable on Death (POD) Trust Account
All Accounts
Designate Specific Account(s)
Beneficiary
_____________________________________
Street
_____________________________________
City/State/Zip
_____________________________________
Relation to Member
_____________________________________
Beneficiary
_____________________________________
Street
_____________________________________
City/State/Zip
_____________________________________
UTTMA/UGMA (as custodian for
_____________________________________ (minor)
under the Uniform Transfers/Gifts to Minors Act
Minor's TIN/SSN
_____________________________________
(Instruction to Signer: If you have been notified by
the Internal Revenue Service (IRS) that you are subject
to backup withholding due to payee underreporting and
you have not received a notice from the IRS that the
backup withholding has terminated, you must strike out
the language in clause 2 of the certification you sign
below.)
CERTIFICATION AS TO TAXPAYER IDENTIFICATION
NUMBER AND BACKUP WITHHOLDING
Under penalties of perjury, I certify (1) that the
number shown on this form is my correct taxpayer identification
number (2) that I am not subject to backup with-holding
either because I have not been notified that I am subject
to backup with-holding as a result of a failure to report
all interest or dividends, or the Internal Revenue Service
(IRS) has notified me that I am no longer subject to
backup withholding and (3) that I am a U.S person (including
a U.S. resident alien).
