For office use:                                      Collection Point ………………….....................……..

IID Checked:  Y/N                 
 Residential   Y/N      Officers Name: …………………….......
Identity         Y/N       Officers Name: ……………………………….
Other           Y/N        Officers Name: ……………………………….

Membership fee paid Y/N          Initial Share allocation paid:  Y/N
Payroll Deduction Y/N               Standing Order Y/N

Application approved by: ………………………… ..Member of Board of Directors