Dividend Application Form - Police Credit Union

Account Number: *

Account Number. E.g Police - 10212345, Civilian - 60212345, Tobago Civilian 60312345, SRP -20212345

First Name / Middle: *

Last Name: *

Current Address:

Email Address: *

Phone Number:

ID/DP/PP Number: *

Please distribute my DIVIDENDS for the year

as follows:

Options available for payment *

Name of Bank: *

Branch: *

Bank Account Number: *

Amount: *

Loan Type: *

Amount:

Loan Type:

Amount:

Loan Type:

Amount:

Loan Type:

Amount:

Loan Type:

Select a payment option below: *

Transfer to SharesTransfer to DepositTransfer to LINCU Active Card

*ACH Transfer Applies for Dividend Amount in excess of $100.00.

**Transfer to Deposit will only be honoured for amounts of $100.00 or under

Disclaimer:

The Trinidad and Tobago Police Credit Union will not be held liable for any payment errors/delays that may occur as a result of incorrect/illegible/incomplete information provided on the Dividend Application Form.