Membership Application Form

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Treasure Link Cooperative Society of Edmonton

Edmonton, Alberta

APPLICATION FOR REGULAR MEMBERSHIP


Please read before you proceed. Fill up completely and submit with 2x2 ID picture. Please include a photocopy
of a government issued ID (passport, Driver's license, PR Card, Alberta Health Card)
Last Name : Contact No :
Given Name : email add :
Middle Name : Status : Gender :
Date of Birth : Age :
Address :
No. of Years staying
Source of Income :
If employed include position and office :
Address of Employer : Years Employed :
Complete Name of Spouse : Date of Birth :
Source of Income of Spouse :
Character Reference
Complete Name Address Contact Number

Beneficiaries
Complete Name Date of Birth Relationship

In the event of death, I appoint the above listed beneficiaries to withdraw the proceeds of my fixed deposits or any
benefits I am entitled to.
Should my membership be approved, I promise to:
Subscribe the minimum share capital of CAN$1,000.00 and thereby paying in lump sum
open a savings account and gradually save for a period of ten (10) months until such time that the
minimum shar capital is completed.

I promise to abide by the duties and responsibilities of a full pledged member - to deposit regularly, pay obligations
promptly, patronize, promote and support the cooperative's Programs and Services.
I hereby certify that the above infotmation are true and correct and that I will abide with the rules, policies and
philosophies of the cooperative.

Any false information given above upon certification shall be an AUTOMATIC CAUSE OF DISQUALIFICATION OF
TERMINATION of my membership.

Signed this day of at

Signature Over Printed Name of Applicant


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