St.Kitts Credit Union

I hereby make application for membership in and agree to conform to the rules and any amendments thereto of the St. Kitts Co-operative Credit Union Ltd.
Name	Date of Birth / /
Address	Ocupation
	Email
Home Telephone Number	Work Telephone Number
Cellphone Number
Designation of Beneficiary
This Designation is only effective when delivered to and filed with the ST. KITTS CO-OPERATIVE CREDIT UNION LIMITED
I, , being a member of the St. Kitts Co-operative Credit Union Limited do hereby designate the following:
Nominee One	Address
Proportion to be Paid/Transferred

Nominee Two	Address
Proportion to be Paid/Transferred

Nominee Three	Address
Proportion to be Paid/Transferred

Nominee Four	Address
Proportion to be Paid/Transferred
As my Beneficiary (ies), to receive any and all sums of money that may become due and payable to me at the time of my death by the said Credit Union. I hereby, reserve the right to change the Beneficiary (ies) herein designated. The execution by a subsequent Designation of Beneficiary Form shall constitute a change of beneficiary.