Youth Initiative Cooperative
Credit Union Limited (YouthCCUL)
Credit Union Limited (YouthCCUL)
Account Opening Form
Taking Financial Dreams to Reality
Complete clearly in BLOCK LETTERS. Tick all applicable options.
1. Application & Account Type
Date of application (DD/MM/YYYY):
Account type (select one or more):
Savings account
Current account
Time and term deposit account
Preference share investment
2. Applicant Information
Full name of applicant:
Date of birth (DD/MM/YYYY):
Place of birth:
Occupation:
Residential address:
Email address:
Contact number 1:
Contact number 2 (optional):
3. Identification Document
Select identification document:
National ID card
Passport
ID card / passport number:
Expiry date:
Date of issue / place of issue:
Youth Initiative Cooperative
Credit Union Limited (YouthCCUL)
Credit Union Limited (YouthCCUL)
Account Opening Form
Taking Financial Dreams to Reality
4. Next of Kin / Beneficiary
Full name:
Relationship:
Contact number:
Address:
5. Employment & Source of Income
Employment status:
Employed
Self-employed / Business owner
Student
Retired
Other
Employer / business name:
Employer / business address:
Monthly income range (FCFA):
6. Declaration & Signature
I hereby declare that the information provided in this form is true and correct to the best of my knowledge.
I agree to abide by the rules, regulations, and bye-laws of Youth Initiative Cooperative Credit Union Limited
and acknowledge that providing false information may result in cancellation of my membership.
Applicant signature:
Date (DD/MM/YYYY):
Passport
Photo
(2×2 inch)
Photo
(2×2 inch)
Affix recent photo
For Office Use Only
Account number:
Processed by:
Date:
Supervisor approval signature: