In order for the account to be opened in the name of the Association, the Association must have its own Taxpayer Identification Number. Otherwise the account must be opened in the name and SSN of the Managing Organizer below. 1. SELECTION OF ACCOUNT TYPE AND TITLING OF ACCOUNT - Select and Complete One Portion T Unincorporated Association/Club or Benevolent Fund with Taxpayer Identification Number I certify that the association referenced is engaged in an independent activity and is administered by a charter, Bylaws and/or other controlling document. I agree to provide DCU with a certificate signed by the association secretary or clerk, verifying my authority and the authority of those listed below to establish an account and transact business on behalf of the association. I acknowledge and agree the Credit Union is relying on statements and representations contained in this agreement and its sole obligation is that of a depository institution with no fiduciary responsibilities Account Title: _____________________________________________________________ ( Must match TIN assignment , if applicable, to open account - See Section V) Business Address: ________________________________ _________________________________ Phone: (____)_______________ T Benevolent Fund without Taxpayer Identification Number I certify that the purpose of the account for which I am applying is to deposit contributions/donations made in the name and for the benefit of an individual or individuals who have experienced a hardship and that the funds will then be distributed to that individual(s) and the account closed. Name of Fund: ____________________________________________________________ I understand this account will be opened and reported in the name and Social Security Number of the Managing Organizer below and that another Organizer must be named with access to this account. I acknowledge and agree the Credit Union is relying on statements and representations contained in this agreement and its sole obligation is that of a depository institution with no fiduciary responsibilities 2. FIELD OF MEMBERSHIP Both the Managing and Additional Organizer must complete this section, if either is already a DCU Member, they need only fill in their DCU Personal Membership #, Legal Name, and SSN Managing Organizer (Signer) DCU Personal Membership # (if applicable) ____________________ Legal Name _________________________________ SSN _____-_____-_____ DOB _________/_________/_________ Phone (_______)__________________ License # (if different than SSN) __________________ Residential Address ____________________________________________ Apt #_____ City/State/ZIP _________________________________________ Select One : R I am able to join through my Employer: _________________________, located in ________________________, ___________ who is a DCU sponsor Company Name City St/Country R I am able to join as a member of: ___________________________________________________________________________ Name of Organization or Association R I am able to join through an Immediate Family Member sponsor which you may verify (inlcudes spouse or domestic partner, grand/child, parent, or sibling) This person’s Name is: _____________________________________________ and DCU Member Number is: ________________________ Additional Organizer #1 (Signer) DCU Personal Membership # (if applicable) ____________________ Name _____________________________________ SSN _____-_____-_____ DOB _________/_________/_________ Phone (_______)__________________ License # (if different than SSN) __________________ Address ____________________________________________________ Apt #_____ City/State/ZIP ____________________________________________ Select One : R I am able to join through my Employer: _________________________, located in ________________________, ___________ who is a DCU sponsor Company Name City St/Country R I am able to join as a member of: ___________________________________________________________________________ Name of Organization or Association R I am able to join through an Immediate Family Member sponsor which you may verify (inlcudes spouse or domestic partner, grand/child, parent, or sibling) This person’s Name is: _____________________________________________ and DCU Member Number is: ________________________ IMPORTANT INFORMATION: We are required, by federal law, to obtain, verify, and record information that identifies each person opening or having access to a DCU Account. We will ask for your legal name, residential address, Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN), Phone Number, and Date of Birth. REQUIRED IDENTIFICATION: No individual can be named on this account in any capacity without having provided the following current identification, one of which must include a picture and one of which must reflect the Individual’s current residential address as given . If one of these forms of identification includes both you need only submit that one: i US Driver's License i US Social Security Card i Passport i US Military ID i US Work Visa i Other Government Issued picture ID (2 nd ID always required). DCU reserves the right to request additional identification. If you are already a DCU member, joint owner, or co-borrower you are not required to provide the REQUIRED IDENTIFICATION. But you must provide your DCU Member #, Legal Name, and SSN above Digital Federal Credit Union 220 Donald Lynch Boulevard., • Marlborough, MA 01752 800/328-8797 • web: www.dcu.org • email: dcu@dcu.org Account Number: ___________________________ (assigned by DCU) Application and Agreement for Unincorporated Association Account or Benevolent Fund 5. AGREEMENT AND TAXPAYER ID NUMBER (TIN) CERTIFICATION AND BACKUP WITHHOLDING Agreement: I certify that I am at least 18 years of age and am within the field of membership, whether by way of employment, organizational or associational affiliation, or an immediate family relationship as defined in your Truth-in-Savings (TIS) Disclosure and Account Agreement s. Signing below and/or use of my PIN constitutes an agreement to conform to the terms and conditions of the TIS Disclosure and Account Agreements, the Electronic Services Disclosure and Agreements , the Visa Credit Card Agreement and Federal Truth-in-Lending Disclosure, and the Schedule of Fees and Service Charges all of which are incorporated by this reference, whether applicable to products and services I am currently requesting or those I request in the future. Easy Touch Telephone Teller and Internet PC Branch will be immediately accessible. I may obtain a copy of any of these disclosures at any branch office or through your Information Center. These disclosures (as applicable) will be mailed to me once my membership has been opened. I authorize you to gather and exchange whatever credit, checking account and employment information you consider appropriate from time to time and understand you may make credit or other decisions based in part on this information. Taxpayer Identification Number (TIN) - Enter your TIN in the box below. For individuals, this is your social security number (SSN). However, if you are a resident alien and do not have and are not eligible to get a SSN, your TIN is your IRS individual taxpayer identification number (ITIN). If the account is in more than one name, see the chart in the TIS Disclosure for guidelines on what number to enter. Typically this will be the Prime Owner's SSN. TIN/SSN Box: Payee exempt from Backup Withholding. See Part iii Instructions In TIS Disclosure Certification - Under penalties of perjury, I certify that: (1) The information on this form is true, correct, and complete and if proven otherwise you may demand payment in full on any debt I have outstanding with you or revoke any services I use, and (2) The number shown on this form is my correct taxpayer identification number, and (3) I am not subject to backup withholding because: (a) I am exempt from backup withholding and have completed and delivered to you the appropriate exemption form, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding I agree to cross out number 3 just previous if I have been notified by the IRS that I am subject to backup withholding because I have failed to report all interest and dividends on my tax return, and (4) I am a U.S. person (including a U.S. resident alien). The IRS does not require me to consent to any of the provisions of this document other than the certification required to avoid backup withholding. AUTHORIZED SIGNATURES (must include ALL individuals listed in Sections 2 and 4): Each of the persons who sign below is duly authorized to act with respect to the account and the credit union is authorized to act in all matters relating to the account upon the order of any one of the persons who sign below until the credit Union receives written instructions to the contrary. Only authorized signatories can be changed or removed. ___________________________________________________________ __________________________________________________________ Signature Date Signature Date ____________________________________________________________ ___________________________________________________________ Signature Date Signature Date 4. ADDITIONAL ORGANIZER(S) ADDITIONAL ORGANIZER (if applicable) who will have access to the account (Must ALL be in the Field of Membership): DCU Member Number and (Printed) Name: If not a DCU Member, must also Complete the Following: 2.# _________________ _______________________ SSN____________________ DOB________________ PHONE (_____)_____________ ADDRESS ______________________________________________________________ Eligibility (Family Member Number, Sponsor Company Name, or Organization Name through which I am joining): _________________________________________________ 3. #_________________ _______________________ SSN____________________ DOB________________ PHONE (_____)_____________ ADDRESS ______________________________________________________________ Eligibility (Family Member Number, Sponsor Company Name, or Organization Name through which I am joining): _________________________________________________ 3. DCU ACCOUNT SERVICES – Check those that apply Primary Savings ($5*) R Checking ** R Money Market ($1,000***) R PC Branch R DCU Check Card ** (if checked, this is automatically issued in the name of the individuals listed in Section 2) * Minimum deposit required to open ** Upon Approval *** Minimum to open/earn dividends Code Word: I will remember this (up to 10 letter) word for telephone transactions through your Call Center: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ INTERNAL USE ONLY Rec’d _____________________ Proc By #________________ X-Ref #____________________________ Audit By #______________ Managing Organizer DP DOC ______________________________________ Additional Organizer #1___________________________________________ Additional DOC _________________________________________________ Additional DOC _________________________________________________ Additional Signatory #2 DP DOC ___________________________________ Additional Signatory #3 ____________________________________________ Additional DOC ________________________________________________ Additional DOC __________________________________________________ M734 (03/2004)