Page 1 of 1
Opt-out request
™Vancity Community Investment Bank is a trademark of Vancouver City Savings Credit Union, used under license.
Form_0928 (2017-07-20)
Once completed, please mail this completed form to:
Vancity Community Investment Bank
Corporate Privacy Oce
401-183 Terminal Avenue
Vancouver, BC V6A 4G2
Opt-Out Request
These privacy choices will not aect my eligibility for products or services. By opting-out, I am opting-out for all
my Vancity Community Investment Bank™ (“VCIB”) products and services.
Check all that apply:
1. Please do not inform me of any new products or services, special promotional oers, nancial advice by:
Mail Telephone Email
2. Please do not contact me for research or surveys by:
Mail Telephone Email
3. Please do not share my personal information within the Vancity Group.
Personal Information
By opting-out, I understand that:
• I will not receive information on any new products or services, special promotional oers, or nancial advice.
However, I will continue to receive account statements and various statement inserts (if applicable).
• I will not be solicited for feedback on VCIB products and services.
• I can change my mind on these choices at any time by notifying VCIB in writing.
• This opt-out request may require up to 10 days to take eect.
First Name Middle Initial Last Name
Prepaid Card / Account Number
Apt / Unit Number Street Address
City / Town Province / State Postal / Zip Code Country
X
Member Signature Date Signed (yyyy-mm-dd)
Internal Use Only
Employee Name Employee Number Date Received (yyyy-mm-dd)
Input completed on these systems Forwarded to Copy to Privacy Oce 183 Terminal Ave.
Visa
Other Department
(please specify: )
Yes
