© 2019 Navy Federal NFCU 97CI (8-19)
Please print and use black ink pen to fill in the blanks.
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If you provide a cell phone number, Navy Federal has your permission to place automated non-marketing calls and text messages to that number. Message and data
rates may apply. Visit navyfederal.org for more information.
Name: First MI Last Suffix Access No. Social Security No. (SSN)
Name: First MI Last Suffix
Current Home Address: Street
Cannot Be a
Post Office Box
City State Zip Code
Mailing Address: Street
If Different From
Above Address
City State Zip Code
Date of Birth (MM/DD/YY) Social Security No. (SSN) or ITIN Cell Phone No.
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Other Contact No.
Email Address
Employer’s Name Job Title Type of Business No. of Years With Employer
Employer’s Address: Street City State Zip Code Office Phone No. Other Source(s) of Income
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Rank Rate
Re-enlistment/EAOS Date (MM/DD/YY)
Please see next page for Joint Owner information.
3
Stocks, alimony, pension, etc.
This document contains both information and form fields. To read information, use the Down Arrow from a form field.
Navy Federal
®
Change of Information/Add Joint Owner (for applicants 18 and over)
Use this form to change personal information or add Joint Owner Information.
A. My Current Information
B. My New Information
1
1
Changing your name, date of birth, and/or SSN or ITIN requires additional documentation. Please see below for acceptable documents.
(Only complete information that is changing.)
Mr. Ms.
Mrs. Miss
I do not wish to disclose
C. My New Employment Information
DoD Military Civilian DoD Employee Non-DoD Civilian Employee
Retired, but Employed Fully Retired Not a Wage Earner
Acceptable Documents
Social Security Number Change
(Please provide one.)
• Social Security Card
• Other Documentation With Full SSN From
Social Security Administration
Date of Birth Change
(Please provide one.)
• Birth Certificate
• State or Government-Issued Photo ID
With Date of Birth
Full Name Change
(Please provide one from each category.)
Photo ID with new name:
State or Government-Issued Photo ID
Second document with new name:
• Court Document
• Social Security Card
Proof of previous name:
• Marriage License
• Divorce Decree
• Court Document
Last Name Only
(Please provide one from each category.)
Proof of previous last name:
• Marriage License
• Divorce Decree
• Court Document
Proof of new last name:
State or Government-Issued Photo ID
Clear
Savings
Checking
MMSA/Jumbo MMSA
Joint Owner Access No.
Name: First MI Last Suffix Date of Birth
(MM/DD/YY)
Social Security No. (SSN) or ITIN
Current Home Address: Street
Cannot Be a
Post Office Box
Zip Code
No. of Years at Residence Issue Date (MM/DD/YY) Exp. Date (MM/DD/YY)
ID No. State
Email Address (required for Online Banking) Cell Phone No.
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Other Contact No.
City
State
Please see next page for important disclosures, required signatures, and submission instructions.
Employer’s Name Rank Job Title Type of Business No. of Years With
Employer
Employer’s Address: Street City State Zip Code Office Phone No. Other Source(s) of Income
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© 2019 Navy Federal NFCU 97CI (8-19)
Page 2 of 3
4
If you provide a cell phone number, Navy Federal has your permission to place automated non-marketing calls and text messages to that number. Message and data
rates may apply. Visit navyfederal.org for more information.
5
Stocks, alimony, pension, etc.
Joint Account–
D. Joint Owner Information
A Joint Owner who wishes to be removed from an account will need to complete a Voluntary Removal of Joint Owner request, NFCU 596. Current
members only need to ll in the Access Number and accounts that he/she should be added to, and complete the signature area.
Add Joint Owner to the following accounts: (Please list full account numbers below.)
All Non-IRA Certificates or the following Certificates:
List Certificates:
Issue Joint Owner: Navy Federal Debit Card
(checking account required)
Mr. Ms.
Mrs. Miss
I do not wish to disclose
Driver’s License, Government ID, or State ID
Enroll me in Navy Federal
Online Banking
E. Joint Owner Employment Information
The survivorship designation on your membership/savings account applies to all other joint accounts with the same joint
owner, unless specically designated otherwise for a particular account in writing. If a survivorship option has not been
indicated here, your accounts will be designated as Joint With Survivorship.
Joint Account With Survivorship
(On the death of an account owner, the deceased’s shares pass to the
surviving owner.)
No Survivorship
(On the death of an account owner, the deceased’s shares pass
to the estate.)
Select
Signature of Applicant (required)
Date (MM/DD/YY)
Signature of Joint Owner (if applicable)
Date (MM/DD/YY)
Specify document used as proof of maiden name (e.g., Marriage License, Divorce Decree) SOB Code
___________________________________________________________________
Employee No.
____________________________________________________________________
Access No.
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F. Disclosure Agreement and Survivorship Designation
Account Disclosures: I/We acknowledge that membership at Navy Federal
comes with certain ongoing responsibilities. By signing this document,
I/we acknowledge receipt of and agree to all terms and conditions in the
Important Disclosure booklet and all other disclosed terms and conditions of
all accounts and services that I/we may receive at Navy Federal. These terms
and conditions will be disclosed in accordance with applicable state and
federal laws. I/We understand that Navy Federal may restrict or suspend my/
our access to products or services if I/we engage in conduct that is abusive to
the credit union or it’s membership.
Consumer Reports: I/We authorize Navy Federal to obtain a consumer
credit report to evaluate my/our creditworthiness so that I/we may be
considered for other Navy Federal products and services. I/We also authorize
Navy Federal to obtain consumer reports for the purposes of evaluating this
membership application and reviewing any Navy Federal accounts I/we open.
I/we understand these reports may be used in decisions to deny account
applications, close accounts, and/or restrict accounts or services.
Escheatment: I/We acknowledge that my/our property may be transferred to
the appropriate state (i.e., “escheated”) if there has been no activity on any of
my/our accounts within the time period specified by state law.
Identification: Federal law requires all financial institutions to obtain, verify,
and record information that identifies each person who opens an account,
including joint owners and authorized signers. What this means for you: When
you open an account, we will ask you for your name, address, date of birth,
and other information that will allow us to identify you. We may also ask to see
your driver’s license or other identifying documents. It may be necessary for
Navy Federal to restrict account access or delay the approval of loans pending
further verification of your identity or documentation related to your eligibility.
Statutory Lien: I/We acknowledge and pledge to Navy Federal a statutory lien
in my/our shares and dividends on deposit in all joint and individual accounts
and any monies held by Navy Federal now and in the future, to the extent of
any loan made and any charges payable. The statutory lien does not apply to
shares in any Individual Retirement Account.
Security Interest: I/We acknowledge and pledge to Navy Federal a security
interest in the collateral securing loan(s) that l/we have with Navy Federal now
and in the future, including any type of change or increase, and any proceeds
from the sale of such collateral and of insurance thereon, not to exceed the
unpaid balance of the loan. This security interest in collateral securing loans
does not apply to any loan(s) on my/our primary residence.
Contractual Lien: I/We authorize Navy Federal to transfer funds from any
accounts in which I/we have an ownership interest to correct a negative or
overdrawn amount on any account on which my/our name(s) appear(s). My/
Our authorization applies to all funds I/we voluntarily deposit into Navy Federal
accounts, including Social Security funds, as permitted by law.
G. Required Signatures and Tax Certication
By signing, I/we acknowledge that I/we have read and agree to the information/disclosure above.
Tax Certication (This certification does not apply if I have checked the box below my signature.)
Under penalty of perjury, I certify that (1) the SSN/ITIN provided is correct, (2) I am not subject to backup withholding, and (3) I am a US Citizen
or US resident alien.
The FATCA code certication does not apply.
The Internal Revenue Service does not require your consent to any provision of this document other than the certications required
to avoid backup withholding.
By checking this box, I certify that I am a non-resident alien and I have completed a Form W-8BEN.
By checking this box, I certify that I am a non-resident alien and I have completed a Form W-8BEN.
Note: If you are the Attorney-in-Fact, a copy of the Power of Attorney (POA) is required. Please ensure that the POA specifically authorizes you to be added
as a Joint Owner.
Submission Instructions
Fax: Fax completed form and supporting documents to 703-206-4600, ATTN: “Membership Administration.”
Mail: Send completed form and photocopy of supporting documents to Navy Federal Credit Union, P.O. Box 3002, Merrifield, VA 22116-9887.
Online: Sign into Online Banking > Select “Messages” tab > Select “Send us a message” tab > Under “My Message is About,” select “General” >
Under “Regarding,” select “Add/Remove Joint Owner” > Fill out subject as “Change of Information” > Attach completed 97CI and any
supporting documents according to “Acceptable Documents” (above).
Branch: Go to navyfederal.org/branches-atms/index.php to find your closest branch office
.
For Office Use Only
Documents Used to Produce Name Change
(Please indicate which documents were used.)
Documents Accepted to Change Last Name Only
(Must have one form of ID that shows new name.)
Driver’s License Passport Military ID
Court Document (specify):
Documents Accepted to Change Full Name
(Must have two forms of ID that show new name.)
Driver’s License Passport Social Security Card Military ID
Court Document (specify):
© 2019 Navy Federal NFCU 97CI (8-19)
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