EFTA00124737.pdf

MC MurncipAt CREDIT UNION U PO Box 3205 Church Street Station New York, NY 10007 (212) 6934900 ACCOUNT SIGNATURE CARD Account Number: Basis for Membership: Em louse of the CI Amends Existing Information L X Verification Issued By: NY Gender: Male x Female Me — Please tell us about yourself Noel Tova A Last Name First Name Middle Initial Suffix Date of Birth Social Security Number Mother's Maiden Name Phone Center ID Home Phone (MM/D0NYYY) (mother's last name before marriage) (4-digits required) Number House # NS Street Name Street NS APT/ APT! City ST Zip Code EW Type EW FL FL# MAILING ADDRESS (where to direct mad other than the home address) If adding a PO BOX address, check here House # NS Street Name Street NS APT/ APT! City ST Zip Code EW Type EW BOX BOX# STUDENT Student Employer Name Job. Title Seg. Group Wad( # 1.000.00 2 0 Cell/Motile Phone Number Citizenship Gross Income/Month Cash Deposit Amt/Month #Incoming WireslMonth Email Address Re-Type Email Address (for verification) State Drivers License ID 1 Type ID 1 Number ID 1 Description ID 1 Expiration Date School Identification ID 2 Type ID 2 Number ID 2 Description ID 2 Expiration Date Joint Account Holder Verification Issued By: Gender: Female .Male Check if address same as Primary — 1 Amends Existing Information Add Joint Account Holder Last Name First Name Middle Initial Suffix Date of Birth Social Security Number Mother's Maiden Name Phone Center ID Home Phone Number (MWDOMYYY) (mothers last name before marriage) (4-digits required) House # NS Street Name Street NS APT! APT/ City ST Zip Code EW Type EW FL FL# Employer Name Job Title Seg. Group Work # Relationship to Primary Member Cell/Mobile Phone Number Citizenship Gross Income/Month Cash Deposit Amt/Month #Incoming Wires/Month Email Address Re-Type Email Address (for verification) ID 1 Type ID 1 Number ID 1 Description ID 1 Expiration Date ID 2 Type ID 2 Number ID 2 Description ID 2 Expiration Date i EFTA00124737 MC MUNICIPAL CREDIT UNION U U PO Box 3205 Church Street Station New York, NY 10007 (212) 693.4900 ACCOUNT SIGNATURE CARD Beneficiary Information (optional) Check if address same as Primary Last Name Date of Birth First Name Social Security Number House # NS Street Name EW Middle Initial Suffix Relationship to Primary Member Home Phone Number Street NS APT! APT! City ST Lp Code Type EW FL FL# Beneficiary Information (optional) Check if address same as Primary Last Name First Name Date of Birth Social Security Number House it NS Street Name EW X Shales Money Market Middle Initial Suffix Relationship to Primary Member Home Phone Number Street NS APT! Type EW FL X Accounts/Services To OPEN: X FasTrack checking X Touch Tone Teller APT! City ST Zip Code FL# Accounts/Services To RE-OPEN X Instant ATM/Check Card Alternative Checking E-Statement x MCU OnLine Banking Young Executive Convert Young Executive/EasySave Account WRG Temporary Password X Order Checks Mailed ATM/Check Card I hereby apply for membership and subscribe for at least one share (55.00) in the Municipal Credit Union and agree to conform to its ByLaws and amendments thereof. I agree to be governed by the Account Agreement, Rules and Regulations and Schedule of Dividends. Service Charges and Fees of the Municipal Credit Union applicable to Share. FasTrack Checking. Vacation. Holiday and Money Market accounts as now in effect and as from time to time amended. I agree to be bound by the terms and conditions of the MCU Cash Connection, MCU ATM/Check Card. MCU OnLine Banking, and Touch Tone Teller Agreements (which will be later mailecVprovided to me), upon my first use of such servioe(s). I understand that the designations made on this signature card/form will apply to all MCU deposit accounts which are or will be in the future maintained under the same root account number (except IRA, Youth Club, and Share Certificate accounts), and will have the effect of revoking all previous designations made with regard to such accounts. If a joint tenant has been designated on this signature card, it is agreed that these accounts be payable to either of us and upon the death of one of us. to the survivor. Also, it is agreed that any joint tenant may. without the consent of or notice to the other, pledge all or any part of the shares in these accounts as collateral security for a loan with MCU. If a beneficiary (beneficiaries) has (or have) been designated on this signature card, it is agreed that this is a voluntary and revocable trust, and that upon my/our death, the funds in these accounts, and all other deposit accounts maintained under the same root account number (except IRA. Youth Club, and Share Certificate accounts). will become the properly of the named beneficiary or beneficiaries who are alive at the time of my/our death in equal proportions. If both a joint tenant and a beneficiary (or beneficiaries) have been designated on this signature card, it is agreed that the beneficiary(ies) will only acquire an interest in these accounts upon the death of the last surviving joint tenant. By signing below. VWe authorize Municipal Credit Union to perform a credit investigation including the verification of the information on this application. Verification of income and employment may also be required. Under penalties of perjury, I certify (1) that the number shown on this form Is my correct taxpayer identification number; and (2) that I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of failure to report all Interest or dividends, or because the Internal Revenue Service has notified me that I am no longer subject to backup withholding; and (3) I am a U.S. citizen (including a U.S. resident alien). The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding. Accd 09/23/16 Date Joint Account Holder Signature Date Yes, I elect to accept the Check Imaging option and agree to pay the associated service charge. If Joint Account Holder requests an MCU ATMIChedc Card, check this box. Coop City Branch KHADIJAH IBRAHIM Sponsor Account Number Branch Name Member Service Representative EFTA00124738