MEMBER UPDATE & REACTIVATION FORM
MEMBER NUMBER: MEMBER NAME: (First/Middle/Last) [ ] Mr. [ ] Ms. [ ] Mrs. [ ] Dr. Date of Birth
DD/MM/YYYY
XXX-XXX-XXXX)
Email Address: Telephone #:( Taxpayer Registration Number (TRN)
ID(Type & Number) Issue Date: Expiry Date:
Current Address: ___________________________________________________________________________________
__________________________________________________________________________________________________
Residential Status: ○ Own ○ Rent ○ Other _______________________ Since(Month/Year): ___________________________
Place of Birth: _______________________________ Country of Citizenship: ___________________________________
Are you a: US Citizen or Green Card Holder or US National □ No □ Yes
IF YES Taxpayer Identification Number (TIN) …………………………………………………… TYPE: ……………………………………………………………………...…
PROOF OF ADDRESS □ Utility Bill (within 3 months old), □ Letter from JP □ Post marked Envelope □ Site Visit to Residence
Employer: _______________________________________________________________________________
EMPLOYMENT
INFORMATION
Address: ________________________________________________________________________________
Occupation: __________________________________ Employment Date: _____________________________
Average Annual Income $ _______________________ Source of Income: _____________________________
Average Expected Deposit (JMD) ( ) Under $20,000 ( ) $20,001 - $50,001 ( ) $50,001 - $100,000 ( ) over $100,000
Do you or your immediate family (parents, siblings, spouse, children, stepchildren, in-laws) and close associates
POLITICALLY
PERSONS
EXPOSED
hold or has held any of the following positions locally or internationally? Please provide details:
Member of the Judiciary, Military official above the rank of Captain, Member of the police of or above the rank of Assistant Commissioner Head of State,
Head of Government, Minister of Government, Member of any house of Parliament, Official of any political party, Director or Chief Executive of any
company in which the Government owns a controlling interest, Senior management position in an international organization and/or Permanent Secretary,
Chief Technical Director or Chief Officer in charge of the operations of a Ministry, department of Government, Executive Agency or Statutory body.
NAME: _______________________________________________ RELATIONSHIP:________________________________________
NOT LIVING WITH YOU)
(NEAREST RELATIVE
CONTACT
ADDRESS: _______________________________________ EMPLOYER:_______________________________________
_________________________________________________ ADDRESS: ________________________________________
TEL NO: __________________________________________ __________________________________________________
OCCUPATION:_________________________________ TEL NO:______________________________________
Employer (HR Manager and higher // /Police Officer (Rank Inspector and higher) // Minister of Religion) // Attorney-at-Law // Medical Doctor
// JP/Notary Public COK Sodality Member (>2 years) Principal // Manager of Financial Institution (where applicant has an account, // COK
Sodality Board/Committee Member // COK Sodality Employee (Supervisory level )
(Any Two of the Following)
REFERENCES
Name: ____________________________________________ Name: __________________________________________
Address:__________________________________________ Address: ________________________________________
__________________________________________________ ___________________________________________
Tel No:(_______)____________________________________ Tel No:_(______)__________________________________
Reference Type: _________________________________________ Reference Type: ________________________________________
ACCOUNT REACTIVATION: REASON:
Share Golden Egg Standing Order Resume Savings Withdrawal Other _____________________
Member Signature: ________________________________ Approver: _______________________________________
Date: ________________________________ Date: _______________________________________
FOR INTERNAL USE ONLY
FOR INTERNAL
References : REFERENCE #1 VERIFIED REFERENCE #2 VERIFIED
USE ONLY
Entered by: ____________________________ _______________________ ________________
(Name) (Signature) (DD/MM/YYYY)
Reviewed by: ____________________________ _______________________ ________________
(Name) (Signature) (DD/MM/YYYY)
Updated – February 2019 The Bank of Jamaica (BOJ) requires periodic updates of members’ information.
