Financial record, 2009-01-21

INFORMATION ON JOINT MEMBER¶

Name			Social Security Number
Home Address	City		State
Work Phone Number	Home Phone		Employer Name
ID Type	ID Number	ID Description	ID Expiry

The undersigned acknowledges receipt of a copy, and agrees to be governed by the rules and regulations of the Municipal Credit Union applicable to Vaca Club Accounts as now in effect and as amended from time to time.¶

Under penalties of perjury, I certify (1) that the number shown on this form is my correct taxpayer identification number; and (2) that I am not s withholding either because I have not been notified that I am subject to backup withholding as a result of failure to report all interest or dividend Revenue Service has notified me that I am no longer subject to backup withholding.¶

SIGNATURE OF JOINT MEMBER¶

EFTA00124680¶

Account Number:¶

Please tell us about yourself¶

X ChexSystems: Pass¶

		J
Last Name	First Name	Middle Name
11/01/84	057-70-0794	SILVIA
Date of Birth	Social Security Number	Mother’s Maiden Name
BROOKLYN	NY	11205
Street Address (including Apt #)	City	State

Mailing Address (including Apt #)	City	State	ZIP
DEPT OF PROBATION
Employer
NEW YORK	NY	10004	Employer Address
City	State	ZIP	Work Phone Number

---

Email Address¶

State Drivers Licens¶

ID 1 Type	ID 1 Number	ID 1 Description	ID 1 Expiration Date
Job Identification		PROBATION	12/31/09

ID 2 Type	ID 2 Number	ID 2 Description	ID 2 Expiration Date

| ID 3 Type | ID 3 Number | ID 3 Description | ID 3 Expiration Date |¶

Joint Account Holder¶

ChexSystems¶

Last Name	First Name	Middle Name	Suffix (Jr. Sr.)
Date of Birth	Social Security Number	Mother’s Maiden Name	Home Phone Number
Street Address (including Apt #)	City	State	ZIP
Mailing Address (including Apt #)	City	State	ZIP
Employer	Employer Address
City	State	ZIP	Work Phone Number

Email Address	Re-type Email Address (for verification)
ID 1 Type	ID 1 Number
ID 2 Type	ID 2 Number
ID 3 Type	ID 3 Number

EFTA00124681¶

Beneficiary Information (optional)¶

Last Name	First Name	Middle Name	Suffix (Jr.Sr.II)
Date of Birth	Social Security Number	Relationship to member	Home Phone Number

Street Address (including Apt#) City State ZIP¶

Beneficiary Information (optional)¶

Last Name	First Name	Middle Name	Suffix (Jr.Sr.II)
Date of Birth	Social Security Number	Relationship to member	Home Phone Number
Street Address (including Apt#) City State ZIP

Accounts/Services To Open:¶

• ☒ Shares
• ☒ FasTrack checking
• ☒ ATM/Check Card
• □ Alternative Checking
• ☐ Money Market
• ☒ Touch Tone Teller
• ☒ MCU OnLine Banking
• ☒ Order Checks

Date: 01/21/09¶

I hereby apply for membership and subscribe for at least one share ($5.00) in the Municipal Credit Union and agree to conform to its By-Laws and amendments thereof. I agree to be governed by the Account Agreement, Rules and Regulations and Schedule of Dividends, Service Charges and Fees of the Municipal Credit Union applicable to Share, FasTrack Checking, Vacation, Holiday and Money Market accounts as now in effect and as from time to time amended. I agree to be bound by the terms and conditions of the MCU Cash Connection, MCU ATM/Check Card, MCU OnLine Banking, and Touch Tone Teller Agreements (which will be later mailed/provided to me), upon my first use of such service(s).¶

I understand that the designations made on this signature card/form will apply to all MCU deposit accounts which are or will be in the future maintained under the same root account number (except IRA, Youth Club, and Share Certificate accounts), and will have the effect of revoking all previous designations made with regard to such accounts.¶

If a joint tenant has been designated on this signature card, it is agreed that these accounts be payable to either of us and upon the death of one of us, to the survivor. Also, it is agreed that any joint tenant may, without the consent of or notice to the other, pledge all or any part of the shares in these accounts as collateral security for a loan with MCU. If a beneficiary (beneficiaries) has (or have) been designated on this signature card, it is agreed that this is a voluntary and revocable trust, and that upon my/our death, the funds in these accounts, and all other deposit accounts maintained under the same root account number (except IRA, Youth Club, and Share Certificate accounts), will become the property of the named beneficiary or beneficiaries who are alive at the time of my/our death in equal proportions. If both a joint tenant and a beneficiary (or beneficiaries) have been designated on this signature card, it is agreed that the beneficiary(ies) will only acquire an interest in these accounts upon the death of the last surviving joint tenant.¶

By signing below, I/We authorize Municipal Credit Union to perform a credit investigation including the verification of the information on this application. Verification of income and employment may also be required.¶

Under penalties of perjury, I certify (1) that the number shown on this form is my correct taxpayer identification number; and (2) that I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of failure to report all interest or dividends, or because the Internal Revenue Service has notified me that I am no longer subject to backup withholding; and (3) I am a U.S. citizen (including a U.S. resident alien). The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding.¶

	01/21/09
Account Holder Signature	Date
Joint Account Holder Signature	Date

If Joint Account Holder requests an MCU ATM/Check Card, check this box.¶

Yes, I elect to accept the Check Imaging option and agree to pay the associated service charge.¶

	Brooklyn Branch	KAMAL RAMKISSOON
Sponsor Account Number	Branch Name	Member Service Representative

EFTA00124682¶