Saint Vincent And The Grenadines
Police Co-operative Credit Union Limited
Application For Membership
Section A. Personal Information
Section B. Employment Information
Tick all that apply
Section D. Foreign Account Tax Compliance Act (FATCA) Declaration
(If yes, copies of relevant passport(s) to be provided and give details)
If Yes, Provide Details.
-W-9 or W-8BEN
-Document validating US citizenship
-Non-US passport or similar documentation establishing foreign citizenship
W-9 or W-8BEN
-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 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.
Section E. General Information
[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]