PO Box 3205 Church Street Station ¥ ICU New York, NY 10007 (212) 693-4900 Account Number: 9 Basis for Membership: Employee of the Ci ACCOUNT SIGNATURE CARD Amends Existing Information Please tell us about yourself % Verification Issued By: ny _ Gender: |Male ___/Femalems _ Noel Tova A Last Name First Name Middle Initial Suffix Date of Birth Social Security Number Mother's Maiden Name Phone Center ID Home Phone (MM/DDIYYYY) (mother's last name before marriage) (4-digits required} Number —— House # NS Street Name Street NS APT/ APT/ City ST Zip Code EW Type EW FL FLit MAILING ADDRESS (where to direct mail other than the home address) If adding a PO BOX address, check here House # NS Street Name Street NS APT/ APT/ City ST Zip Code EW Type EW BOX BOX# STUDENT Student Employer Name Job. Title Seg. Group Work # ; 1,000.00 2 Cell/Mobile Phone Number Citizenship Gross Income/Month Cash Deposit Amt/Month #incoming Wires/Month Email Address Re-Type Email Address (for verification) State Drivers License | = ID 1 Type ID 1 Number ID 1 Description ID 1 Expiration Date School Identification | | | ID 2 Type ID 2 Number ID 2 Description ID 2 Expiration Date Joint Account Holder Verification Issued By: Gender: Male Female Check if address same as Primary Amends Existing Information Add Joint Account Holder Last Name First Name Middle Initial Suffix Date of Birth Social Security Number Mother's Maiden Name Phone Center ID Home Phone Number (MMIDDIYYYY) (mother's last name before marriage) {4-digits required) House # NS Street Name Street NS APT/ APT! City ST Zip Code EW Type EW FL FLi#t Employer Name Job Title Seg. Group Work # Relationship to Primary Member Cell/Mobile Phone Number Citizenship Gross Income/Month Cash Deposit Amt/Month #incoming Wires/Month Email Address Re-Type Email Address (for verification) ID 1 Type ID 1 Number ID 1 Description ID 1 Expiration Date ID 2 Type ID 2 Number ID 2 Description ID 2 Expiration Date EFTA00124737

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y Now York, MY 10007 ACCOUNT SIGNATURE CARD CUTEST (212) 693-4900 Beneficiary Information (optional) Check if address same as Primary Last Name First Name Middle Initial Suffix Date of Birth Social Security Number Relationship to Primary Member Home Phone Number House # NS Street Name Street NS APT! APT! City ST Zip Code Ew Type EW FL FL# Beneficiary Information (optional) Check if address same as Primary Last Name First Name Middle Initial Suffix Date of Birth Social Security Number Relationship to Primary Member Home Phone Number House # NS Street Name Street NS APT! APT! City ST Zip Code Ew Type EW FL FL# x Accounts/Services To OPEN: Accounts/Services To RE-OPEN Shares < FasTrack checking Instant ATM/Check Card Alternative Checking Money Market Touch Tone Teller E-Statement ¢ MCU OnLine Banking % Order Checks Young Executive Convert Young Executive/EasySave Account WRG Temporary Password Mailed ATM/Check Card | hereby apply for membership and subscribe for at least one share ($5.00) in the Municipal Credit Union and agree to conform to its By-Laws and amendments thereof. | agree to be governed by the Account Agreement, Rules and Regulations and Schedule of Dividends, Service Charges and Fees of the Municipal Credit Union applicable to Share, FasTrack Checking, Vacation, Holiday and Money Market accounts as now in effect and as from time to time amended. | agree to be bound by the terms and conditions of the MCU Cash Connection, MCU ATM/Check Card, MCU OnLine Banking, and Touch Tone Teller Agreements (which will be later mailed/provided to me), upon my first use of such service(s). | understand that the designations made on this signature card/form will apply to all MCU deposit accounts which are or will be in the future maintained under the same root account number (except IRA, Youth Club, and Share Certificate accounts), and will have the effect of revoking all previous designations made with regard to such accounts. if a joint tenant has been designated on this signature card, it is agreed that these accounts be payable to either of us and upon the death of one of us, to the survivor. Also, it is agreed that any joint tenant may, without the consent of or notice to the other, pledge all or any part of the shares in these accounts as collateral security for a loan with MCU. If a beneficiary (beneficiaries) has {or have) been designated on this signature card, it is agreed that this is a voluntary and revocable trust, and that upon my/our death, the funds in these accounts, and all other deposit accounts maintained under the same root account number (except IRA, Youth Club, and Share Certificate accounts), will become the property of the named beneficiary or beneficiaries who are alive at the time of my/our death in equal proportions. If both a joint tenant and a beneficiary (or beneficiaries) have been designated on this signature card, it is agreed that the beneficiary{ies) will only acquire an interest in these accounts upon the death of the last surviving joint tenant. By signing below, |/We authorize Municipal Credit Union to perform a credit investigation including the verification of the information on this application. Verification of income and employment may also be required. Under penalties of perjury, | certify (1) that the number shown on this form is my correct taxpayer identification number; and (2) that | am not subject to backup withholding either because | have not been notified that | am subject to backup withholding as a result of failure to report all interest or dividends, or because the Internal Revenue Service has notified me that | am no longer subject to backup withholding; and (3) | am a U.S. citizen (including a U.S. resident alien). The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding. 09/23/16 Acc Date Joint Account Holder Signature Date Yes, | elect to accept the Check Imaging option and agree to pay the associated service charge. If Joint Account Holder requests an MCU ATM/Check Card, check this box. Co-op City Branch KHADIJAH IBRAHIM Sponsor Account Number Branch Name Member Service Representative EFTA00124738