© 2021 Navy Federal NFCU 97CI (4-21)
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Specify document used as proof of maiden name (e.g., Marriage License, Divorce Decree) SOB Code
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__________________________________________________________________
Employee No.
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__________________________________________________________________
Access No.
Signature of Primary Owner (required)
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Date (MM/DD/YYYY)
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Signature of Joint Owner (if applicable)
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Date (MM/DD/YYYY)
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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 its 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 Certication
By signing, I/we acknowledge that I/we have read and agree to the information/disclosure above.
Tax Certication (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 certication does not apply.
The Internal Revenue Service does not require your consent to any provision of this document other than the certications 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 Military ID
Court Document (specify):
