TRINTOC (PENAL) CREDIT UNION CO-OPERATVE SOCIETY LIMITED

Member Information Update

90A Clarke Road, Penal, 710424, Trinidad, West Indies Tel: (868) 270-7966, 270-7964, 333-0605, 348-5584 * email: info@trintocpenalcu.com

Member Name*

Type your Full Name

Home Address*

Ensure that your current address is stated.

Mailing Address*

Please state if your mailing address is different from your Home Address.

Date of Birth*

Marital Status*

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Home Telephone Number

(xxx-xxxx)

Mobile Number*

Type your Contact Number

Email*

Please ensure that your email is inputted correctly

EMPLOYMENT INFORMATION

Employment Status*

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Employer*

Date joined Company*

Employer's Address*

Employer's Tel Number*

Occupation*

Sector Employed*

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Pay Frequency*

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Average Monthly Income Range*

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VAT Registration #*

Certificate of Incorporation: Copy Provided*

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DOMESTIC AND FOREIGN POLITICALLY EXPOSED PERSONS (PEPs)

Individuals who are or have been appointed to a prominent office/function in Trinidad and Tobago or by a foreign country

Are you a Politically Exposed Person*

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Head of State*

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Senior Politician e.g. Member of Parliament, Senator or Alderman*

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Senior Military Official e.g. Coast Guard, Defense Force*

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Senior Judicial Officials e.g. Chief Justice, Judge, Magistrate, The Registrar, Deputy Registrar*

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Senior Government Official e.g. Permanent Secretary, Accounting Officer under the Exchequer & Audit Act or holding similar positions*

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Senior Executive of State Owned Corporations e.g. Chairman, Deputy Chairman, President /Vice President Secretary, Treasurer, Director, General Manager, Comptroller*

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Immediate Family member e.g. Parent, Spouse, Children and their Spouse*

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Close personal / professional associate of the PEP*

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Persons who are or have been entrusted with prominent functions by an international organization which refers to members of Senior Management e.g. Members of the Board*

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4. Member's Signature

I hereby certify that the above information is true and correct as at the date of completion. Note:You are require to visit the Trintoc (Penal) Credit Union office on completion and submission of online form and sign. Note: This document would be considered incomplete without your signature

4. Date of Signature

FOREIGN ACCOUNT TAX COMPLIANCE ACT (FATCA) DECLARATION

Document Required • W-9 or W-8BEN • Document supporting US citizenship • Non-US passport holder, similar documents to be provided supporting foreign citizenship If yes, copies of relevant passport(s) to be provided and give details • W-9 or W-8BEN

FATCA Declaration*

Are You a Citizen of the USA or other country

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Are you a US citizen, resident or green card holder? If YES, please Provide details?*

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Are you a citizen of any county other than Trinidad and Tobago?*

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Do you have a standing instruction to transfer dividend or regular income to US account?*

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Are you a person who must comply with disclosure requirement of Tax Residency?*

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If yes, please list the Country(ies) or Residency for Tax Purposes and Corresponding Social Security Number (SSN) or Individual Tax Identification Number (ITIN) details.*

5. Member's Signature

5. Date of Signature

File Upload*

Upload the Required Documents Evidence of Employment - (if Permanent, Contract/Temporary). Utility Bill (Most Recent) 2 Forms of Identification Business Registration Certificate - (If Self-Employed).

Drag and drop files here or

For Official Use

Verification of submitted documents.

Documents Received*

Office MUST upload all submitted Documents to the Member's Smartsheet row.

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FINANCIAL OBLIGATION REGULATION

Member's status pending compliance review*

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