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

30 March 2017
Membership Application with Direct Debit

Currently being updated

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

Membership Application with Direct Debit
* Required Fields
I confirm that I work for the NHS/NHS Contractor and agree to provide a copy of a current payslip, when contacted, to verify this fact.: *Yes
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 you first hear about us? *
Work Details
* Required Fields
Health Authority: *
Job Title: *
Ward/Department: *
Address: *
Post Code:
Work Telephone 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: *
* Required Fields
I accept the account information and conditions of membership as detailed as part of this application: *Yes
I have read and understood the UK FSCS information sheet and exclusions list contained within the terms and conditions: *Yes
I agree to having my identity and address checked: *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 taxpayer in the United Kingdom: *Yes - Please enter United Kingdom in the box below
No - Please enter country of residence and where taxes are paid in the text box below
Country of residence and where taxes are paid: *
* Required Fields
Please use this space to add any comments or additional information (if required):

Member Number___________________ Processed by:_____________ Date:________________

Direct Debit Authorisation Form
* Required Fields
I agree to pay the NHS Credit Union by Direct Debit.
I will sign and return the mandate posted out to me to begin the payment process.
Pay Frequency: *
How much are you looking to save from each weekly or monthly Direct Debit?
£ *

N.B. If you are looking to borrow soon you must have a minimum of 1 loan repayment value in your savings


Your FULL name: *
Enter the code shown:
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.