Form of beneficiary nomination

As a member of the above credit union, I hereby nominate the person(s) below, to be the recipient(s) of up to £5000 of my shares held in the credit union, as is my entitlement through the Co-operative and Community Benefit Societies Act.

Processing notes for staff
The form can be used to nominate a new beneficiary which will replace any existing beneficiary on the account. 1. Check all details supplied match our member records 2. Email or text the member's registered email/number notifiying them that a change to beneficiary has been received and they should contact us if it wasn't them 3. delete any previous beneficiary details and input the new details 4. attach to pdf of this form to member records.
Beneficiary Name Beneficiary Name Title First Middle Last Suffix
This is the full name of the person you want to receive your money if you die
Address Address
Street Address Address Line 2 City County Postcode Country
The address of the person named above where we can contact them
Phone

Telephone contact details of the named person
Email

Email address of the named person
How is this person related to you?

How is this person related to you?
I understand that:

1 This entitles the named nominee to claim up to £5000 of shares or deposits, including any insurance entitlement, that may be mine at the time of my death.
2 The credit union has the right to use any of my funds to pay any balances owed to it prior to releasing the funds to the nominee.
3 This nomination will remain in place until I choose to revoke it.
4 Any subsequent marriage I enter will effectively revoke this nomination unless I state otherwise.
5 This nomination will take effect irrespective of any other arrangements I have made in relation to my estate after my death.
6 Any additional funds I hold will be treated as part of my estate and will not be part of this nomination.
7. This nomination revokes and replaces any previous beneficiaries that have been nominated
Your membership number
Must be between 1 and 4 digits. Currently Entered: 0 digits.
You can find this on any membership card, email or statement that we have sent to you
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Your address as registered on our system
Mobile Phone
Your date of birth Your date of birth / DD / MM YYYY
Your email address
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.