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Tel: 0141 445 0022 Fax: 0141 440 2294 Email:

28 March 2017
Membership Application with Payroll

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

Membership Application with Payroll
* Required Fields
Have you been a member of the NHS Credit Union before? *Yes
Personal Details
* Required Fields
Title: *
First Name: *
Surname: *
Middle Name:
Address: *
Post Code: *
Date of Birth: *
National Insurance Number: *
Contact Details
* Required Fields
Home Telephone Number: *
Mobile Telephone Number:
E-mail Address: *
How did you hear about the NHS Credit Union?
* Required Fields
How did your first hear about our services: *
Bank Details
* Required Fields
We would be obliged if you could provide your bank details this will enable us to make withdrawal payments directly into your bank account.
Bank Name: *
Bank Address: *
Sort Code: *
Account Number: *
Designation of Beneficiary
* Required Fields
In the event of my death, I nominate the following as the person to whom there shall be transferred such property in the Credit Union as may be mine at the time of my death, whether in shares or otherwise.
Nominee First Name: *
Nominee Surname: *
Relationship to you: *
Address of Nominee: *
Post Code: *
Work Details & Payroll Authority
* Required Fields
Please fill out the following form to authorise payments to be taken from your pay.

We will print this off and post it back to you for signing, as your pay office require an original signature to authorise these payments.
Full Name: *
National Insurance Number: *
Member Number
Health Authority: *
Job Title: *
Ward/ Department: *
Work Address: *
Post Code:
Workplace Tel No.: *
Payroll Number: *
Pay Division (Scotland Health Boards Only):
Group Code (Scotland Health Boards Only):
Paypoint (Scotland Health Boards Only):
Pay Frequency: *
How much are you looking to save from each weekly or monthly pay?
£ *
I authorise you to deduct from my salary/wage the above amount each pay day and remit the amount so deducted to the NHS Credit Union Ltd.
N.B. If you are looking to borrow soon you must have a minimum sum equal to the value of one loan repayment in your savings.

I agree that the NHS Credit Union may amend my deduction according to my credit union commitment and give my pay office permission to transfer personal data to the credit union in order to make deposits into my account.


* Required Fields
I accept the account information and conditions of membership as detailed as part of this application: *Yes
I agree to having my identity and address checked: *Yes
I have read and understood the UK FSCS information sheet and exclusions list contained within the terms and conditions: *Yes
I authorise the Credit Union to make whatever enquiries are deemed necessary to process this application: *Yes
I confirm that the information supplied on this form is, to the best of my knowledge, correct, and that I meet the NHS Credit Union Common Bond criteria: *Yes
Full Name: *
Date: *
Tax residence
* Required Fields
I confirm that I am a full time resident and tax-payer in the United Kingdom: *Yes - Please enter United Kingdom in the text box below
No - Please enter country of residence and where taxes are paid in the text box below
Country of residence and country where taxes are paid: *
* Required Fields
Please use this space to add any comments or additional information (if required):

Member Number___________________ Processed by:_____________ Date:________________
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Helps prevent automated form submissions.
More Info
NHS Credit Union Limited Tel: 0141 445 0022 Fax: 0141 440 2294 Email: Web:
NHS (Scotland & North England) Credit Union Ltd is Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. ‘NHS Credit Union Ltd’ is a registered trading name of NHS (Scotland & North England) Credit Union Ltd.