Name:
First MI Last Sufx Access No. Date of Birth (MM/DD/YY) Social Security No. (SSN)
Joint Owner (if applicable):
First MI Last Sufx Access No. Date of Birth (MM/DD/YY) Social Security No. (SSN)
© 2019 Navy Federal NFCU 97HX (6-19)
Signature of Applicant (required)
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Date (MM/DD/YY)
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Signature of Joint Owner (if applicable)
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Date (MM/DD/YY)
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This document contains both information and form fields. To read information, use the Down Arrow from a form field.
Navy Federal
®
Membership Agreement and Tax ID Certication
Please print and use black ink pen to ll in the blanks.
This form is NOT to be used to change Member data, add or remove a joint owner on an existing account, or change account information.
To add a joint owner, please submit a “Change of Information/Add Joint Owner” form (97CI).
A. Member Information
B. 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.
Joint Account—With Survivorship
(On the death of an account owner, the deceased’s shares pass to the surviving owner.)
Joint Account—No Survivorship
(On the death of an account owner, the deceased’s shares pass to the estate.)
The survivorship designation on my membership/savings account
applies to all other joint accounts with the same joint owner, unless
specifically designated otherwise for a particular account in writing.
If a survivorship option has not been indicated here, my accounts will
be designated as Joint With Survivorship.
C. 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 certifications
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.
Account Funding–A $5.00 deposit is required to establish membership.
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 “General Inquiry” > Fill out subject as “Tax ID Certification” > Attach completed 97HX.
Branch: Go to navyfederal.org/branches-atms/index.php to find your closest branch office.
