Online Juvenile Membership

Step 1 - About You

Membership of Dubco Ireland is currently open to the following groups and their extended family members:

All permanent, continuous and contract employees & retirees of working in the following sectors:

Local Authorities
Special Needs Assistant members of Fórsa Trade Union
Fast Moving Consumer Goods (FMCG) Employees including
1. Wholesale and Retail Grocery Employees
2. Wholesale and Retail Pharmacy Employees
3. Employees in Pharma & Grocery Manufacturers
Dental Employees including Dentists, Orthodontists, Dental Nurses, Hygienists & Administrative Employees
Non-teaching Employees in all levels of the Education Sector including public & private organisations
Government Organisations including the Housing Finance Agency & Tusla
Members of the CSNA (Convenience Stores and Newsagents Association) and their Employees

Membership is also open to members of the families of any of the previously mentioned groups

Are you a family member of an existing member? *YesNo

If you have ticked no please review the criteria above.

Relationship to Existing Family Member? *

Name of Existing Family Member: *

Street Address: *

City/Town: *

County: *

Phone: *

Dubco may contact your family member to verify the relationship.

Membership Information Pack: *yesI confirm I have downloaded and understood the membership information pack and its terms and conditions.

Step 2 - Becoming A Member

Becoming a Dubco Credit Union member is simple. However, you will need to provide the following:

Proof of ID - must be in date:

Passport
EU National Identity Card (EU Country)
Birth Certificate

Proof of Address - dated within the last 6 months:

If the child cannot provide proof of address, then proof of address of one parent along with photo ID of that parent is acceptable

Utility Bill / Confirmation of Insurance Letter (Home/Car)
Statement from Bank / Credit Union (not Dubco)
Revenue Commissioners Correspondence
Document issued by Government Department showing your address and your PPS number

Proof of PPS number¹:

Correspondence from Revenue Quoting PPS Number
Medical Card, Drugs Payment Scheme Card, E111 Card

¹PPS number is not obligatory but would be appreciated. Dubco is obliged to ask for proof of PPS.

Verify and upload your identity documents *using the ID-Pal appemail a scanned copy to membership@dubco.ie

Step 3 - Applicant Details

Name: *

PPS Number: *

Date of Birth: *

Day

Month

Year

Phone/Mobile: *

Address: *

Town: *

County: *

Eircode: *

Find your Eircode

From where do you derive your wealth? E.g. employment, savings, investments etc. (the source of wealth) Please note, if a parent is saving on behalf of their child, it is their source of wealth. *

For what purpose do you require the account? E.g. savings, loans, budgeting etc. (the business relationship) *

Step 4 - Declarations

This is to be completed by or on behalf of the applicant:

Are you a Close Associate or Family Member of a Politically Exposed Person1? *YesNo

If you ticked ‘Yes’, please explain why: *

I confirm I am and will be the Beneficial Owner1 of the funds in the account. *YesNo

If you’ve ticked ‘No’, please explain why: *

If you ticked ‘No’, please give the name and address of the Beneficial Owner of this account: *

I confirm that I am a Tax Resident1 in the Republic of Ireland Only. *YesNo

If you ticked ‘No’, please give the Tax Identification Number (TIN) & Country of Tax Residence below (proof of TIN will be required).

Tax Identification Number (TIN) *

Country of Tax Residence *

I acknowledge receipt of the Depositor Information1 Sheet *Yes

I acknowledge receipt of the European Union (Payment Services) Regulations 20182 Sheet *Yes

¹For more information, please refer to page 2 of the Membership Information Pack.
²For more information, please refer to page 3 of the Membership Information Pack.

Step 5 - Other Preferences

Please include me in the Death Benefit Insurance (DBI) Scheme (currently €0.25 per month1). *YesNo

Were you a member of Dubco previously? *yesno

If you ticked ‘Yes’, please provide an email address (can be parent’s/guardian’s):

¹Please note & subject to change the Death Benefit Insurance Scheme cost is voted upon at the AGM annually.

Step 6 - Approval Requirements

To be completed by the parent(s)/guardian(s), if the applicant is under the age of 16*

The applicant must nominate his/her parent/guardian to give all acknowledgements on their behalf in respect of the account, regardless of who opens the account. This instruction can be changed in writing by the parent/guardian to allow the child to withdraw money from the account. (Anyone can lodge to the account.)

I/We hereby apply for membership in the name of said (juvenile’s name): *

and I/we acknowledge that all shares/deposits arising from this membership now and hereafter shall be his/her sole property and all withdrawals shall be applied to his/her sole benefit.

I confirm I will notify the Credit Union in writing of any changes in the information which I have provided and any other relevant/material information of which I may become aware at any time after the date of this Declaration.

I hereby apply for membership and agree to abide by the rules of Dubco Credit Union Limited and declare that the information given by me on this form is true and correct to the best of my knowledge. I have read and understand this Membership Pack.

1st Parent/Guardian Name: *

Date *

Mobile Number: *

Please tick if the parent/guardian is already a member of Dubco:Yes

Membership/Pay number: *

If Applicable:

2nd Parent/Guardian Name:

Date

Mobile Number:

Please tick if the parent/guardian is already a member of Dubco:Yes

Membership/Pay number: *

Account number *

Proof of ID and proof of address is required for each parent/guardian signing above.

NOTE: On or after the date that the juvenile family member reaches 16 years of age the juvenile family member hereby confirms that they will complete an Adult Membership Form and submit the identification documentation as deemed appropriate by Dubco. Pending the completion of the formalities as stated above Dubco Credit Union Limited may maintain an open account for the juvenile family member on such terms and conditions as it deems appropriate.

Step 7 - Regulatory Requirements

For the avoidance of doubt, this is not an application for credit as defined by the Consumer Credit Act, 1995. However, the information contained in this application together with the Dubco Consents to use and disclosure for the purposes of (i) the General Data Protection Regulation (GDPR) (Data Protection Acts 1988-2018) and s.71, Credit Union Act, 1997, and (ii) the Irish Credit Bureau and any other Credit Institution, may be used in conjunction with any and all future applications for Credit Facilities from Dubco Credit Union Limited the Member may submit.
Type of Account Opened: Member should be aware that the Account opened will be treated as a ‘Special Share Account’. This means that the dividend due on this account will be credited net of DIRT (Deposit Interest Retention Tax) by the Credit Union. The tax applied will be the prevailing rate.
The Payment Services Information / ‘Regulation 76 Information’ / ‘The European Union (Payment Services) Regulations 2018’ sets out the terms and conditions relating to electronic payments to and from Dubco accounts, including Share Accounts, Deposit Accounts, Loan Accounts and Budget (Bill Payment) Accounts.
I hereby apply for membership of and agree to abide by the rules of Dubco Credit Union Limited and declare that the information given by me on this form is true and correct to the best of my knowledge. I understand that any false or misleading information given by me in connection with my application for membership with the Credit Union may result in termination of my membership, apart from any other legal sanctions that may apply
I confirm I will notify the Credit Union in writing of any changes in the information which I have provided and any other relevant/material information of which I may become aware at any time after the date of this Declaration.

Applicant/Parent/Guardian Consent: *Yes

I understand that under the General Data Protection Regulation (GDPR), my consent may be required for the Credit Union to process personal data that it may have in its possession concerning me (including disclosure to third parties). I note that this personal data may include sensitive personal data, such as data about my health, within the meaning of the GDPR, the processing of which requires my explicit consent.

I also understand that under Section 71 of the Credit Union Act, 1997, the Credit Union, subject to exceptions listed in the Section, shall not disclose or permit to be disclosed, without my consent, any information that concerns an account or transaction of mine with the Credit Union.

Applicant/Parent/Guardian Consent: *Yes

Step 8 - Authority And Indemnity For Telephone Or Electronic Instructions

This allows us to take instructions from you in relation to your account by phone or email.

Instructions by email will only originate from one of the following email addresses:

If the new member doesn’t have an email address, you can use a parent's or guardian's to avail of online services.

Personal/Guardian Email:

2nd Personal/Guardian Email:

Should I require you to transfer money from my Dubco account to my bank account by Electronic Funds Transfer, the following details are those I shall confirm when we instruct Dubco Credit Union Limited to do the transfer:

Bank name:

Bank address:

Account name:

Bank Identifier Code (BIC):

International Bank Account Number (IBAN):

To: Dubco Credit Union Limited (The "Credit Union")

Click here for terms and conditions.

I refer to my Dubco account (s) and mandate (hereinafter referred to as “the Mandate”) between the Credit Union and myself governing the operationof my account(s) with the Credit Union.
Notwithstanding the terms of the Mandate or of any future mandate or other agreement or course of dealing between the Credit Union and myselfI hereby request and authorise the Credit Union (but do not oblige the Credit Union) to rely upon and act in accordance with any instruction orcommunication which may from time to time be or purport to be given by telephone, facsimile or electronic transmission by myself.
The Credit Union shall be absolved of any and all responsibility for any loss or liability of any nature (direct or indirect) suffered by me as a result ofany error in transmission of any telephone, facsimile or electronic instruction or communication or as a result of the Credit Union’s acting on anytelephone, facsimile or electronic instruction or communication the Credit Union believes in good faith to have been made by me and the Credit Unionis authorised to act without further enquiry upon any telephone, facsimile or electronic instruction or communication believed in good faith by theCredit Union to be an instruction or communication so given or made.
The terms of this Authority and Indemnity shall remain in full force and effect unless and until the Credit Union receives (and has reasonable time to actupon) a note of termination from me in writing save that such termination will not release me from my liability under this Authority and Indemnity inrespect of any act performed by the Credit Union in accordance with the terms of this Authority and Indemnity prior to the expiry of such time.

Dubco Credit Union Limited reserves the right to request you to attend their office in person for such purposes and requirements as may be deemednecessary by Dubco Credit Union Limited.

If the above email is not owned by the member, please state who the owner is.

Parent / Guardian name (on behalf of applicant):

Applicant Consent:Agree

Date

Dubco Credit Union Limited reserves the right to instruct you to attend their office in person for such purposes and requirements as may be deemed necessary by Dubco Credit Union Limited.

Step 9 - To Fund The Applicants New Dubco Account

Will this new account will be funded by an existing member?YesNo

If Yes, please enter the existing member details below.

Existing member account number: *

Existing member name *

Once this account has been opened the above member will be contacted to amend their current Dubco deduction.

How will this account be funded?: *Once off paymentOngoing payments by direct debit

A member of our staff will contact you to arrange a lodgement to your new account; e.g. counter lodgement, card payment, EFT, etc.

DIRECT DEBIT MANDATE - (Name and details below confirms mandate)

Creditor: Dubco Credit Union Limited, Little Green Street, Dublin 7. Creditor Identifier: IE98-ZZZ3-038-18

Please provide the details of the account you will use to fund your Dubco account:

Amount: *

Frequency:WeeklyFortnightlyMonthly

Full Name: *

Name on the Account: *

Bank Identifier Code (BIC): *

International Bank Account Number (IBAN): *

Preferred Collection Date *

Consent (Please add the details of the person funding the new account) By ticking the checkbox below, I hereby authorise you to implement the payment mandate selected at the top of this page;

DIRECT DEBIT MANDATE

(A) Send instructions to my bank to debit my account and

(B) For my bank to debit my account in accordance with the instructions from Dubco Credit Union Limited.

As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8weeks starting from the date on which your account was debited. Your rights are explained in a statement that you can obtain from your bank.

CONSENT

By ticking the checkbox below, we hereby authorise you to implement the payment mandate selected at the top of this page;

Mandate Consent *Agree