Individual Form

New Membership Form

    • Saint Vincent And The Grenadines
      Police Co-operative Credit Union Limited
      Application For Membership

    • First 2 digits of passbook number
    • Last 3 digits of passbook number
    • NON-APPLICABLE(N/A) FIELDS SHOULD BE STATED WHERE THE INFORMATION DOES NOT APPLY

    • Section A. Personal Information

    • Date Format: DD slash MM slash YYYY
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    • Section B. Employment Information

      Tick all that apply
    • Date Format: DD slash MM slash YYYY
      (Specifically other source of funds. How will you fund this account? E.g. Savings from bank account)
    • Section C. Nomination of Beneficiary

      In the event of death, I hereby appoint a beneficiary to receive net shares and deposits owing to me in accordance with 5.105(1) of the Co-operative Society Act No. 12 of 2012
    • Section D. Foreign Account Tax Compliance Act (FATCA) Declaration

      Document Required: (If yes, copies of relevant passport(s) to be provided and give details)
      If Yes, Provide Details. Document Required: -W-9 or W-8BEN -Document validating US citizenship -Non-US passport or similar documentation establishing foreign citizenship
      Document Required: W-9 or W-8BEN
      Document Required: -W-9 or W-8BEN
      If Yes, please list the Country(ies) of Residency for Tax Purposes and Corresponding Social Security Number (SSN) of Individual Tax Identification Number (ITIN) details
    • If you have ANSWERED NO TO ALL the questions in this section, please sign below

    • Member's Signature: _________________________________

    • Date Format: DD slash MM slash YYYY
    • If you have ANSWERED YES TO ANY the questions in this section, please complete this declaration:

      UNDER PENALTY OF PERJURY, I CERTIFY THAT:
      i. THE INFORMATION HEREIN IS TO THE BEST OF MY KNOWLEDGE AND BELIEF TO BE TRUE AND CORRECT.
      ii. I AM NOT A CITIZEN OR RESIDENT FOR TAX PURPOSES OF ANY COUNTRY OTHER THAN THOSE LISTED IN THIS SECTION.
      iii. I WILL NOTIFY SVG PCCU LTD IMMEDIATELY IN THE EVENT OF ANY CHANGE TO THE INFORMATION STATED IN THIS SECTION.
      iv. I WILL AGREE THE SVG PCCU LTD CAN PROVIDE TO THE UNITED STATES INTERNAL REVENUE SERVICE (U.S. IRS) AND TO ANY RELEVANT TAX AUTHORITY (OR ANY PARTY AUTHORISED TO ACT ON BEHALF OF SUCH AUTHORITY) ANY OF THE INFORMATION PROVIDED IN THIS SECTION OR ANY INFORMATION THAT MAY BE REQUIRED TO BE PROVIDED BY LAW TO THE U.S. IRS OR OTHER RELEVANT TAX AUTHORITY RELATING TO MY ACCOUNT(S) WITH SVG PCCU LTD CREDIT UNION.

    • Member's Signature: _________________________________

    • Date Format: DD slash MM slash YYYY
    • Section E. General Information

    • Contact Person Information

    • ACCEPTANCE OF YOUR MEMBERSHIP IS ON THE UNDERSTANDING THAT YOU WILL ABIDE BY THE RULES AND BYE-LAWS OF PCCU. FAILURE TO DO SO MAY RESULT IN YOUR EXPULSION FROM THE ORGANISATION.

    • Section F. Politically Exposed Persons (PEPs)

      Individuals who are or have been entrusted with prominent functions by a foreign country or in Saint Vincent and the Grenadines
    • Please tick if you fall into any of these categories:

    [Parliament Members (national or local), Senators]
    [Permanent Secretary, Senior Officer, or holding equivalent positions in a foreign country]
    [Chief Justice, Judges of the Supreme Court (Appeal & High Court Judges), Masters of the Supreme Court, Industrial Court Judges, Caribbean Court of Justice Judges, The Registrar, Deputy Registrar, Assistant Registrar, Chief Magistrate, Deputy Chief Magistrates and Magistrates of the Magistracy]
    [eg. Police Force - Commissioner, Deputy Commissioner, Assistant Commissioner, Superintendent, Assistant Superintendent, Coast Guard]
    [Chairman, Deputy Chairman, President of Vice President of the BOD, Managing Director, General Manager, Comptroller, Secretary, Treasurer or any other person who is duly appointed to perform functions similar to those normally performed by the holder of any office specified]
    [Chairman, Deputy Chairman, Secretary, Treasurer of a political party registered under the Representation of the People Act or individuals holding equivalent positions in a foreign country]
    [Spouse, Parent, Siblings, Children Children of the Spouse of that person]
    [eg. Directors and members of the Board or equivalent functions]
    • If you have answered yes to any of the questions above please complete the Enhanced Due Diligence form.

    • I hereby certify that the above information is true and correct as at the date required.
    • Member's Signature: _________________________________

    • Date Format: DD slash MM slash YYYY
    • Witnessed By _________________________________

    • Date Format: DD slash MM slash YYYY
    • FATCA SUMMARY

    • The Foreign Account Tax Compliance Act (FATCA) is an important development in U.S. efforts to combat tax evasion by U.S. persons holding accounts and other financial assets offshore

      Reporting Thresholds

      Reporting thresholds vary based on whether you file a joint income tax return or live abroad. If you are single or file separately from your spouse, you must submit a Form 8938 if you have more than $200,000 of specified foreign financial assets at the end of the year and you live abroad; or more than $50,000, if you live in the United States. If you file jointly with your spouse, these thresholds double. You are considered to live abroad if you are a U.S. citizen whose tax home is in a foreign country and you have been present in a foreign country or countries for at least 330 days out of a consecutive 12-month period.

      Taxpayers living abroad. You must file a Form 8938 if you must file an income tax return and:

      • You are married filinf a joint income tax return and the total value of your specified foreign financial assets is more than $400,000 on the last day of the tax year or more than $600,000 at any time during the year. These thresholds apply even if only one spouse resides abroad. Married individuals who file a joint income tax return for the tax year will file a single Form 8938 that reports all of the specified foreign financial assets in which either spouse has an interest.
      • You are not a married person filing a joint income tax return and the total value of your specified foreign financial assets is more than $200,000 on the last day of the tax year or more than $300,000 at any time during the year.

      Taxpayers living in the United States. You must file Form 8938 if you must file an income tax return and:

      • You are unmarried and the total value of your specified foreign financial assets is more than $50,000 on the last day of the tax year or mote than $75,000 at any time during the tax year
      • You are married filing a joint income tax return and the total value of your specified foreign financial assets is more than $100,000 on the last day of the tax year or more than $150,000 at any time during the tax year.
      • You are married filing separate income tax returns and the total value of your specified foreign assets is more than $50,000 on the last day of the tax year or more than $75,000 at any time during the tax year. For purposes of calculating the value of your specified foreign financial assets in applying the threshold, include one-half the value of any specified foreign financial asset jointly owned with your spouse. However, report the entire value on Form 8938 if you are required to file Form 8938. (IRS 2013)
      • Politically Exposed Person Summary

        • A politically exposed person (PEP) is an individual who is or has been entrusted with a prominent function. Many PEPs hold positions that can be abused for the purpose of laundering illicit funds or other predicate offences such as corruption or bribery. Because of the risks associated with PEPs, the FATF Recommendations require the application of additional AML/CFT measures to business relationships with PEPs. These requirements are preventative (not criminal) in nature, and should not be interpreted as meaning that all PEPs are involved in criminal activity. (FATF Guidance)