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Application for Dividends

Trinidad and Tobago Police Credit Union

Customer Name:	Account Number:	Email Address:

Current Address:	Contact Number:	ID/DP/PP Number:

Payment option selected:

Name of Bank:	Branch:	Bank Account Number:

Amount:	Loan Type:

I, hereby acknowledge that the above application form will be used for the processing of my 2020 Dividend payment. I also confirm the information provided in this said application form is accurate and has been completed by me without duress. Further, any false or misleading information provided by me can lead to delays in the processing of my Dividend Payments and I will be liable for any cost associated with the rectifying of any errors caused by false information provided.

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Timestamp

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March 8, 2021 9:01 am -04

Application for Dividends Uploaded by Trinidad and Tobago Police Credit Union www.policecreditunion.com - cantoine@ttpcu.sibetasite.com IP 190.213.52.118