Wish to apply for membership of the FOND ST. JACQUES CREDIT CO-OPERATIVE SOCIETY LIMITED. I agree to conform to the Society’s Ordinance, Regulations and By-Laws and adhere to any amendments to the foregoing.

I hereby confirm that the details provided in this form and in any other document provided to the credit union are correct, true and complete, and agree to inform the credit union immediately of any change in the information provided.

I hereby declare that any money remitted into this account does not directly or indirectly originate from any illicit financial activity, and that I have not been, nor shall I be, involved, directly or indirectly, either individually or jointly with any other person(s), in any money laundering or terrorism financing activities.

In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that the credit union reserves the right to withdraw me from its membership.

In accordance with Section 17 of the Co-operative Societies’ Act Chapter 82 Rule 8 of the Co-operative Societies’ Rules, made hereunder, and the Bye-Laws of the above named Society, I hereby nominate the following as the only person (or persons) to whom to credit the Shares, Deposit or Interest of the value of such Shares, Deposit or Interest held by me in the said Society shall in the event of my death be paid or transferred (in the proportions respectively shown hereunder).

Should the appointed beneficiary be a minor (below the age of 16 years) at the date of my death, the legal tutor shall be entitled to receive the benefit on their behalf by installments agreed by Fond St Jacques Credit Cooperative Society Ltd. Upon minor reaching age 16, the assigned Legal Tutor will be considered null and void.