Individual’s Membership Application & Account Opening Form I hereby apply to become a Member of:
Maritime, Mining & Power Credit Union Serving workers of the maritime, mining and power related industries and their families.
Reliance Credit Union is a division of Maritime, Mining & Power Credit Union Ltd. Serving the Central West.
Personal Details Mr
Mrs
Miss
Membership Number Allocated:
Ms
Email Address
Given Name(s) Middle Name
Surname
Work phone
Home phone
Facsimile No
Mobile
(
Residential Address (mandatory)
(
State
Postcode
Mailing Address (write “as above” if same as residential) State
)
(
)
)
Date of Birth
/
/
Occupation Postcode
Other Names I am known by;
Employer Nominate an Account Password (max 19 characters) Mandatory
Other commonly known names do not include nicknames, abbreviations or Anglicised versions of a given names – e.g. Bob for Robert; Joe for Giuseppe. If you are in doubt, record the name(s) above.
Sole Trader Accounts I make the following disclosures about my Registered Business Name:
Registered Business Name Details Registered Business Name
ABN
Principle Business Address Postcode
Selecting your Accounts and Facilities Choice of Account Types (please tick) S1 Access Savings Account
S5 Cash Management Account
S20 Business Account
S2 Budget Savings Account
S6 Power Up eSaver Account
S24 GST Account
S3 Special Purpose Account
S7 Bonus Saver Account
Term Deposit
S4 Christmas Club Account
S8 Pension Security Account
Other
Choice of Account Facilities (please tick) VISA debit card
Internet / Phone Banking
(Not available for accounts where the method of operation requires more than one signature)
rediCARD
Dynamic Sweep
Paper Statements
(requires a Dynamic Sweep Application to be completed)
I acknowledge that I am responsible for ensuring that adequate and up to date security measures are in place on any computer that I plan to access Internet Banking from. I further acknowledge that my transaction limits may be reduced should I not maintain adequate security measures.
Declaration Signature:
Date:
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I hereby apply to be admitted as a member of the Maritime, Mining & Power Credit Union Ltd and to be allotted one $10 share. I agree to pay all charges required by the Credit Union as listed in the rules. I agree to be bound by the rules of the Credit Union and any amendment thereof registered and understand that the Credit Union may charge the shares or the credit balance of my account in relation to any debt I owe to the Credit Union. I consent to the Credit Union being advised from time to time by the appropriate authority of the identity of my employer. I have been given a Conditions of Use for the Accounts and Access Facilities. I have been given a copy of the Privacy Statement. I agree to be bound by the terms and conditions applicable to this/these accounts. I have been given the opportunity to ask questions.
Membership Eligibility / Nomination Section Full name of Related Member
Their Membership Number (If known)
Relationship to you
Related Member’s Signature
OFFICE USE ONLY Membership Number:
Date of Admission to Membership:
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/
Shares:
Shareholder
Non Shareholder
Verification of Identity Details: Member Identification Procedure – Individual carried out and document(s) produced.
Access Facilities Action List Redicard ordered VISA card ordered Cheque Book ordered Internet Banking / Phone banking activated
Operator Name:
No.
Signature:
Date:
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Documentation Certification Statement The law requires us to verify your identity when you open an account or when you become a signatory to an account. The process is easy: Determine which identification type you can provide from the acceptable identification types list overleaf. If you are mailing a copy of your acceptable identification documents ( photocopies accepted ), have the document/s certified by a person on the certifier catagories list. The certifier will need to complete this form. Follow the instructions in the certifier endorsement section below. The certifier cannot be related to you. If you are presenting an original document directly to a Credit Union staff member, then the document does not need to be certified. Do not use correction fluid on this form. Any alteration should be crossed out and initialed.
Account holder’s details Given name
Surname
Certifier’s details Title
Mr
Mrs
Ms
First name
Miss
Other
Listed below are acceptable certifiers who can certify documents Tick the category you, as the certifier, belong to: a person who is enrolled on the roll of the Supreme Court of State or Territory, or the High Court of Australia, as a legal practitioner (however described);
Middle name
Surname Occupation
a judge of an Australian court a chief executive officer of an Australian Commonwealth court;
an Australian magistrate a registrar or deputy registrar of an Australian court;
an Australian notary public;
an Australian police officer;
Residential or Business address ( PO Box not acceptable )
an Australian justice of the Peace; JP registration no.
Unit/Floor/Street No
an agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public;
Street
Suburb/Town Postcode
a permanent employee of the Australian Postal Corporation with 2 or more years of continuous service who is employed in an office supplying postal services to the public;
State
an Australian consular officer or an Australian diplomatic officer (within the meaning of Consular Fees Act 1955); an officer with, or authorised representative of, a holder of an Australian financial services license, having 2 or more continuous years of service with one or more licensees;
Home Phone No
Mobile phone no
Work phone no
a member of the Institute of Chartered Accountants in Australia, CPA Australia or the National Institute of Accountants with 2 or more years of continuous membership.
Documents to be certified – see overleaf for category descriptions List: A B Documentation type
C
B
C
Documentation type Person whom it relates
Person whom it relates List: A B Documentation type
List: A
C
Person whom it relates
List: A B Documentation type
C
Person whom it relates
Certifier endorsement The certifier must ensure the following instructions are adhered to on our behalf. I have examined the original identification documents listed above. I have endorsed copies of all the documentation that you have certified. I have endorsed each copy of the identification document with the following statement: ‘This is to certify that this is a true copy of the original which I have sighted. Date, Name, Signed, Title, Registration Number (if applicable)’ It is an offence under the Anti-Money Laundering and Counter Terrorism Financing Act 2006 (Cth) to give false and misleading information. Date Signature Print Name
Acceptable Identification Types You are required to provide the following identification with your application: 1. One document from List A Photographic Identification 2. One document from List B and one from List C (2 forms of non photographic ID must be provided) These documents will need to be certified. See overleaf.
List A – Primary Photographic Identification Documents current photo driver’s licence or permit by State, Territory or foreign government photo ID Proof of Age card issued by a State or Territory government current passport ( or expired within the last 2 years ) issued by the Commonwealth passport, with photo of the person, issued by a foreign government, the United Nations, or a UN agency - If not in English - accompanied by an English translation prepared by an accredited translator national ID card, with photo and signature of the person, issued by a foreign government, the United Nations, or a UN agency - if not in English - accompanied by an English translation prepared by an accredited translator.
List B – Non- Photographic Identification Documents birth certificate issued by a State or Territory birth extract issued by a State or Territory citizenship certificate issued by the Commonwealth pension card issued by Centrelink birth certificate issued by a foreign government or the UN. If not in English, accompanied by an English translation prepared by an accredited translator.
List C – Secondary Identification Documents a notice that • was issued to an individual by the Commonwealth, a State or Territory within the preceding twelve months e.g Social Security Notice, Taxation Notice. • contains the name of the individual and his or her residential address • records the provision of financial benefits to the individual under a law of the Commonwealth, State or Territory ( as the case may be ) a notice that: • was issued to an individual by the Australian Taxation Office within the preceding 12 months e.g HECS statement, Income Tax statement • contains the name of the individual and his or her residential address • records a debt payable to or by the individual by or to ( respectively ) the Commonwealth under a Commonwealth law relating to taxation a notice that: • was issued to an individual by a local government body or utilities provider within the preceding three months e.g Jury duty Notice, Water, Electricity, Phone, Rates Notice • contains the name of the individual and his or her residential address • records the provision of services by that local government body or utilities provider to that address or to that person a notice that • was issued to a minor by a school principle within the last three months e.g school report, letter from principle • contains the name of the minor and their residential address • records the period of time the minor attended the school
Continued overleaf
Pay Split Authority Member Name/s
Membership No.
Supplier Number
Average Pay
Payment Frequency
Weekly
Payment Frequency
Fortnightly
Monthly
Other
Please disburse my pay to the following accounts:
Membership No.
Account Type e.g. L1
Signature:
Amount ($)
Date:
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OFFICE USE ONLY Pay Split loaded / changed as requested:
Operator Name:
No.
Signature:
Date:
/
Providing your Tax File Number TFN Please use this TFN for all my accounts
TFN Exemption Type
/
Level 7, 217 Clarence St Sydney NSW 2000 PO Box K237 Haymarket NSW 1240 p: 1300 36 2000
[email protected] www.mmpcu.com.au
203-209 Russell St Bathurst NSW 2795 PO Box K237 Haymarket NSW 1240 p: 13 24 40 f: 1800 022 055
[email protected] www.reliance.com.au
Reliance Credit Union is a division of Maritime, Mining & Power Credit Union Ltd. ABN 11 087 650 315 AFSL / Australian Credit Licence 240399
