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Tel: 01604 250016 Email:

22 October 2017
Online Membership Form

Prior to completing this form, please open and review the attached PDF concerning the protection of your deposits through the Financial Services Compensation Scheme (FSCS).

Click to DownloadDownload FSCS Information Sheet (126.5kb)

Please complete all your details in the form below, and click submit when you have finished.

Online Membership Application
* Required Fields
Section One – Personal Information
Title : *
First Name(s): *
Surname: *
National Insurance Number: *
Home Telephone:
Mobile Telephone:
E-Mail Address:
Date of Birth: *
Have you ever previously been a member of Northamptonshire Credit Union in this or any other name? *
Previous Number (if known):
Surname used (if different):
Section Two – Address Details
* Required Fields
Address Line 1: *
Address Line 2:
Address Line 3:
Address Line 4:
Town: *
Postcode : *
Length of time at address (In years and months): *
If you have resided at your current address for less than three years, please provide your previous address
Address Line 1:
Address Line 2:
Address Line 3:
Address Line 4:
Length of time at address (In years and months):
Section Three – Employers Details
* Required Fields
N.B. It is not necessary to be employed to join Northamptonshire Credit Union.
Current Employer:
Address Line 1:
Address Line 2:
Address Line 3:
Address Line 4:
Section Four – Data Protection
* Required Fields
Northamptonshire Credit Union is registered to hold and process personal information (Registration No: Z8547560). All information you give us will be held in accordance with the Data Protection Act 1998 and will only be used to administer your account. It will not be shared with any other person or organisation without your written consent.
From time to time we may wish to send you information about us and our services. In which ways are you happy to receive this information?
E-Mail: *
Text: *
Post: *
Telephone: *
We will contact you to give you information of our Annual General Meeting and on other essential matters such as account statements.
Section Five - Tax Residency Status
* Required Fields
The UK government has, and will be signing, a number of inter-governmental agreements to share tax information, where applicable, with the tax authorities in other jurisdictions. The requirement to collect certain information about each customer’s tax arrangement is part of UK legislation and as a financial service company we are legally obliged to collect it. We are asking for your tax residency and tax ID numbers (where applicable) and will record this on our records now, but will only disclose this information to the relevant tax authorities if and when we are required to under UK law. Your tax residence generally is the country in which you live for more than half a year. Special circumstances (such as studying abroad, working overseas, or extended travel) may cause you to be resident elsewhere or resident in more than one country at the same time (dual residency). The country / countries in which you pay income tax is / are likely to be your country / countries of tax residence. If you are a US citizen or hold a US passport or green card, you will also be considered tax resident in the US even if you live outside the US. If you have any questions on how to complete this form, we recommend that you speak to your tax or legal adviser.
1. Are you a citizen and tax resident of the UK only? *
If no, please answer questions 2 and 3
Are you a citizen of the USA?
Please list the countries other than the UK of which you are tax resident, if any, together with associated tax reference number.
Country/countries of tax residencyTax Reference Number
Section Six – Declaration
* Required Fields
I hereby apply for membership of, and agree to abide by the rules of, Northamptonshire Credit Union. I declare that the information given by me on this form and in support of my membership application is true and correct to the best of my knowledge and belief.
I declare that the tax residency information provided here is true and correct to the best of my knowledge and belief. I also confirm that I have received and understood the Information Sheet and Exclusions List relating to the Financial Services Compensation Scheme.
Signature: *Signature
On receipt of your application, Northamptonshire Credit Union will conduct an online check of your identity and address. Please note that this is not a credit check. In the event that we are unable to verify your details through the online check, we will need to see proof of your identity and address in order to complete the opening of your account.
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Northamptonshire Credit Union Tel: 01604 250016 Email: Web:
Northamptonshire Credit Union is authorised by the Prudential Regulation Authority & regulated by the Financial Conduct Authority & the Prudential Regulation Authority (FRN 213810)