CREDIT UNION

Finance Department, Unity House, 39 Chalton Street, London NWI 1JD RMT CREDIT UNION APPLICATION FORM — please complete your application along with the attached Direct Debit. Please use BLOCK CAPITALS and black ink. 1 PERSONAL DETAILS. Email address Date of Birth National Insurance Number Summers Forenamels) | PP Pi} | tt tt tt Mobile phone Postode Pi ttt | ety | LYLE IZLE 1 | Home phone | | | /\|I/ Marrital Status married | partner’ | ~— single. | — divorced’ | Drivers Licence No. | | 3 Your Employment. emer iin Job Description | 4 Mr) Mrs) Ms|~ Miss | | Membership Status RMT TU Member |_| Retired RMT TU Member |_| RMT Family Member |_| f This is the amount you wish to save by Direct Debit monthly on the 28th | —_or date you next get paid 6 How much do you wish to save £ [Tt Tt | weekly | | if 4 weekly (Fri) [| date here..........s.sssceseeee Normally your payments are made once a month (28th) to RMT Credit Union Ltd. We are checking new member identification electronically. To do Next of Kin this, we now carry out searches with credit reference agencies who supply us with relevant detail including information from the Address Electoral Register. The searches will not be used by other lenders to assess your ability to obtain credit. | agree to my identity being checked electronically |_| If we cannot verify your identity and address by this method, we will ask you to provide paper documentation instead. Full details of these can be supplied to you by calling 020 7529 8835. Your signature Date LT JYLLIZLLI 1 9 | undertake to abide by the rules now in force or those that are adopted. a, Instruction to your Bank or CamT> Building Society to pay by Direct Debit a aren Please fill in the whole form including official use box using a ball point pen and Originator’s Identification Number Send to: RMT Credit Union Ltd., 39 Chalton Street, London NW1 1JD oT 4a a Reference Number a Bank/Building Society | | | | | | | | | | | | | | | | | | | Name and full postal address of your Bank or Building Society FOR RMT CREDIT UNION LTD OFFICIAL USE ONLY Postcode This is not part of the the instruction to your Bank or Building Society. Name(s) of Account Holder(s) | Instructions to your Bank or Building Society. 7 4 Please pay RMT Credit Union Ltd Direct Debits for the account detailed in this instruction subject to the safeguards Bank/ Building Society account number assured by the Direct Debit Guarantee. | understand that this instruction may remain with RMT Credit Union Ltd, if | | | | | | | | | so, details will be passed electronically to my Bank/Building Society. Branch Sort Code Signature(s) LT ILEILE Date Banks and Building Societies may not accept Direct Debit Instructions from some types of account Ne. o~ This guarantee should be detached and retained by the Payer. The Direct Debit Guarantee Aone Debit e This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits. If there are any changes to the amount, date or frequency of your Direct Debit RMT Credit Union Ltd will notify you seven working days in advance of your account being debited or as otherwise agreed. If you request RMT Credit Union Ltd to to collect a payment, confirmation of the amount and date will be given to you at the time of the request. e If an error is made in the payment of your Direct Debit, by RMT Credit Union Ltd or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society. — If you receive a refund you are not entitled to, you must pay it back when RMT Credit Union Lid asks you to. | e You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us. |