affidavit of relationship to open family/household

AFFIDAVIT of Relationship
OAS Staff FCU
1889 F Street, NW y Washington, DC 20006
Tel: 202-458-3834 y Fax: 202-458-3838
MEMBER AND FAMILY MEMBER INFORMATION
Member Name
Account No.
Family Member Name
Email Address
Relationship
Other Non-Family Member
† Mother/Father
† Son/Daughter
† Household Member
† Husband/Wife
† Brother/Sister
† Other______________________________
AGREEMENT AND MEMBER SIGNATURE
By signing this form I certify that the person listed under family member name is
related to me in the manner listed above; that I am enclosing copies of the
necessary forms of identification and, to the best of my knowledge, they are lawful
and valid forms of identification; that I am providing this information under the US
Patriot Act, and that I have a reasonable belief that the information provided is
accurate and current.
Signature
Date
FOR CREDIT UNION USE ONLY
Copias verificadas en (Fecha)
Información completa:
† Si
† No
Cuenta abierta
† Si
Información faltante
Fecha limite para entregar documentación
Verificada por:
Aprobada por:
NOTE: PLEASE INITIAL THE PHOTOCOPIES OF EACH OF THE
VALID IDENTIFICATION CARDS THAT YOU ARE PRESENTING
TO OPEN THIS ACCOUNT.
† No
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