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KFCUR24841-03/20Page 1 of 3
Revocable Trust Irrevocable Trust
Trust Name Established Date
Mailing Address City State Zip
REVOCABLE TRUSTS ONLY - TRUSTOR INFORMATION (IF DIFFERENT FROM TRUSTEES)
Trustor #1 Last Name First Name
Social Security or Tax ID # Date of Birth Mother’s Maiden Name
Trustor #2 Last Name First Name
Social Security or Tax ID # Date of Birth Mother’s Maiden Name
I am eligible to join Kinecta in one of the following ways:
If this is a revocable trust, one or more trustor(s) are member(s) of the Credit Union. If this is an irrevocable trust, either the trustor or beneﬁciary must be members or, in the case of multiple trustors
or beneﬁciaries, all the trustors or all of the beneﬁciaries must be members of the Credit Union. For the trust to become a member with all rights of membership (including voting rights for the
trust), all trustors, trustees and beneﬁciaries must be eligible for membership in the Credit Union.
A $5.00 minimum savings account deposit is required for membership.
Employee of a Select Employer Group (SEG): Company name ________________________________________________________________________________________________
Community Group (CG): Live Work Worship Attends School Anaheim Lancaster Rialto Santa Ana Check ZIP (Requires ZIP Code) _______________
Associational Group (AG): Associational Common Bond (Locals, PTAs, Churches, etc.) ___________________________________________________________________________
Immediate Family Member: Member Name _____________________________________________________________ Relationship _______________________________________
Innovision Society (Must include Innovision Society Membership Application). Co-Op # __________________________________________
USA Patriot Act: Federal law requires that we obtain, verify and record information that identiﬁes each person who opens an account, including all acting trustees. Within this application, we will
ask 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. Approval of your
application may be delayed pending further veriﬁcation of your identity.
Part 1 Taxpayer Identiﬁcation Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the
“Name” line to avoid backup withholding. For individuals, this is your social security number
(SSN). For other entities, it is your employer identiﬁcation number (EIN).
Tax Identiﬁcation Number Employer Identiﬁcation Number
Part 2 Certiﬁcation
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identiﬁcation number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding
because: (a) I am exempt from backup withholding, or (b) I have not been notiﬁed by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure
to report all interest or dividends, or (c) the IRS has notiﬁed me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person. The FATCA code
certiﬁcation does not apply. Certiﬁcation instructions. You must cross out item 2 above if you have been notiﬁed by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of
secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to
sign the certiﬁcation, but you must provide your correct TIN. The Internal Revenue Service does not require your consent to any provision of this document other than the certiﬁcations
required to avoid backup withholding.
£ CHECK BOX IF NON-RESIDENT ALIEN AND DO NOT SIGN THE SIGNATURE LINE ABOVE. MUST COMPLETE A W-8BEN INSTEAD.
This membership application controls all accounts opened and listed in the account number section at the top of this form except Business Accounts. Individual Retirement Accounts (IRA) require an
additional agreement to be executed. I/We understand that if I/we wish to open new accounts under terms and conditions other than those set forth herein, or with different ownership, I/we must
execute a new Master Membership Application/Signature Card (“agreement”). I/We also understand that the terms and conditions set forth in any subsequently-executed agreement shall apply only to
those account numbers listed in the new agreement.
I/we authorize the credit union to obtain consumer credit reports for the purpose of evaluating this application and in the future for other legitimate purposes associated with my/our account(s),
including but not limited to, account review and servicing and collections purposes. I/we authorize and instruct Kinecta FCU (Kinecta) to obtain my consumer credit report from Kinecta’s designated
credit reporting agency(ies), now or in the future, to determine my eligibility for products or services, including in order to market to me. I understand that I may withdraw this instruction by contacting
Kinecta’s Member Contact Center. Upon my/our request, you will provide me/us with the name(s) and address(es) of the consumer reporting agency(ies) that furnished the report(s).
I/We agree to conform to the Credit Union by-laws, the terms and conditions of the Trust Membership Application and Agreements & Disclosures (Share Accounts, Truth in Savings, Electronic Services
provide two forms of valid identiﬁcation including a state or U.S. Government-issued photo ID. As required by federal law, the Credit Union must verify the identity of each person seeking to open an
account (including trustees and co-trustees) and must maintain records of the information used to verify each person’s identity.
Trustee 1 Signature: _______________________________________________________________________________________________ Date:____________________________________________
Trustee 2 Signature: _______________________________________________________________________________________________ Date:____________________________________________
Trustee 3 Signature: _______________________________________________________________________________________________ Date:____________________________________________
Trustee 4 Signature: _______________________________________________________________________________________________ Date:____________________________________________