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 a division of Maritime, Mining & Power Credit Union Serving the Central West. Gosford Credit Union a division of Maritime, Mining & Power Credit Union Serving the Central Coast. Personal Details Mr Mrs Miss Ms Given Name(s) Membership Number Allocated: Email Address Middle Name Surname Work phone Home phone ( ) ( ) Residential Address (mandatory) Mailing Address (write as above if same as residential) Facsimile No ( ) State Postcode Date of Birth Occupation Mobile State Postcode Employer Other Names I am known by; 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 S2 Budget Savings Account S3 Special Purpose Account Other Choice of Account Facilities (please tick) S5 Cash Management Account S6 Power Up esaver Account S8 Pension Security Account Term Deposit VISA debit card (Not available for accounts where the method of operation requires more than one signature) Cheque Book (Requires a Member Cheque Application form and Signatory Card to be completed) Dynamic Sweep (requires a Dynamic Sweep Application to be completed) Internet / Phone Banking. Redicard PLUS 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: 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: 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:
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 Miss Other First name Middle name Surname Occupation Residential or Business address ( PO Box not acceptable ) Unit/Floor/Street No Street Suburb/Town State Postcode Home Phone No Mobile phone no Work phone no 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); a judge of an Australian court a chief executive officer of an Australian Commonwealth court; an Australian notary public; an Australian magistrate a registrar or deputy registrar of an Australian court; an Australian police officer; an Australian justice of the Peace; JP registration no. an agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public; 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; 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; 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 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. Print Name Date Signature
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 Payment Frequency Weekly Fortnightly Monthly Other Please disburse my pay to the following accounts: Membership No. Account Type e.g. L1 Amount ($) Signature: Date: 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
365-375 Sussex St Sydney NSW 2000 PO Box K237 Haymarket NSW 1240 p: 1300 36 2000 f: 02 9264 2018 e: mail@mmpcu.com.au 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 e: admin@reliance.com.au www.reliance.com.au 44 Mann St Gosford NSW 2250 PO Box K237 Haymarket NSW 1240 p: 02 4343 5000 f: 02 4323 7074 e: info@gosfordcreditunion.com.au www.gccu.com.au Reliance Credit Union and Gosford City Credit Union are divisions of Maritime, Mining & Power Credit Union Ltd ABN 11 087 650 315 AFSL 240399