Nuneaton Credit Union.
Share Withdrawal Form
Name: .................................................
Membership No: ........................
Savings Balance
£ .........   ........p
Loan Balance
£ ........   .........p
Please issue me with a cheque in the sum of  £..........   ......p made payable to
.............................................    And debit my account.
Signed ............................................         Date .................................

Do you wish to close your account?   Y/N
I will collect my cheque from  ...................................   Collection point* or
Please post to my home address*   (Delete where appropriate marked *)
oooooOOOooooo THIS SECTION TO BE SIGNED BY MEMBER ON RECEIPT OF CHEQUE.
I acknowledge the receipt of the cheque made out to the sum of £ .........   .....p

Signed: ............................                                Date .............................
N.B. ALL SECTIONS MUST BE COMPLETED FOR THIS APPLICATION TO BE PROCESSED.
Regulated by the Financial Services Authority. Firm Number 213783 Member of ABCUL
Registered office:- Unit 6, Cooperative Arcade, Abbey Street, Nuneaton CV11 5BT, Cooperative Arcade, Abbey Stree Forms Email address ...................................................