Membership Application and Account Card

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Instructions

For existing Star One members only:

Read and accept the two disclosures provided below
Fully complete the form that appears after you accept the disclosures
Agree to the Trust Agreement at the end of the form if opening a Trust
Print the form
Sign the form
Photocopy your valid U.S. driver's license or State-issued ID card
Mail the photocopy and printed form to Star One Credit Union, P.O. Box 3643, Sunnyvale CA 94088-3643

To avoid processing delays, and to collect your most current information, the Member Application and Account Card must be completed in its entirety.

1. Important information about opening a new account

To help our government fight the funding of terrorism and money-laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person when opening a new account.

What does this mean for you? When you open an account, we will ask your name, address, birth date, and other information that will help us to identify you. We may also ask to see some type of positive identification.

2. Accept the two following disclosures

Please carefully read the two following electronic communications disclosures and acknowledge your consent by checking the corresponding "I Agree" buttons:

Membership and Account Agreement

Please carefully read this Membership and Account Agreement disclosure, then acknowledge your consent by clicking the "I Agree" button below.

Checking and Savings Rate and Fee Schedule

Please carefully read this Checking and Savings Rate and Fee Schedule disclosure, then acknowledge your consent by clicking the "I Agree" button below.

Enter your application information

Membership Number:

Purpose of application:

Reason for update:

Purpose of account:

Source of funds:

Account ownership

Designate ownership of the accounts and responsibility for the services requested:

Irrevocable Trust Qualification

All Trustors are members of the Credit Union
All Beneficiaries are members of the Credit Union

Member/Owner

Proprietorship Name:

Owner Name:

SSN/TIN:

U.S. ID Type:

ID Number:

ID Issuing State:

ID Issue Date :

ID Exp. Date:

Birth Date:

Residential Address:

Residential Address, line 2:

City/State/Zip:

Mailing Address:

City/State/Zip:

Home Phone:

Work Phone:

Cell Phone:

E-mail Address:

Employer:

Occupation:

Password Identifier:

Opening deposit

Type of deposit:

Star One account number to transfer from:

Total deposit:

Amount to deposit in Money Market Savings:

Amount to deposit in Checking:

By default, your Money Market Savings serves as overdraft protection for your Checking Account. To specify a different account for overdraft protection, such as Visa, enter the account name here:

Amount to deposit in Sub-Savings:

By default, your Sub-Savings Account is named "Special Savings Account." You may provide a different name for this account here:

Amount to deposit in a Certificate Account:

By default, your Certificate Account dividends remain in the account and are compounded. You may have your dividends transferred to a different Star One account instead, by providing that account number here:

Add account services

Payroll Deduction / Direct Deposit into

Touchtone Teller Access

ATM/Visa Debit Card (checking required for debit card)

Online and Mobile Banking

Bill Pay

Automatic debit from Star One account

Joint Owners

Joint Owner #1:

SSN/TIN:

U.S. ID Type:

ID Number:

ID Issuing State:

ID Issue Date :

ID Exp. Date:

Birth Date:

Residential Address:

Residential Address, line 2:

City/State/Zip:

Mailing Address:

City/State/Zip:

Home Phone:

Work Phone:

Cell Phone:

E-mail Address:

Employer:

Occupation:

Password Identifier:

Joint Owner #2:

SSN/TIN:

U.S. ID Type:

ID Number:

ID Issuing State:

ID Issue Date :

ID Exp. Date:

Birth Date:

Residential Address:

Residential Address, line 2:

City/State/Zip:

Mailing Address:

City/State/Zip:

Home Phone:

Work Phone:

Cell Phone:

E-mail Address:

Employer:

Occupation:

Password Identifier:

Joint Owner #3:

SSN/TIN:

U.S. ID Type:

ID Number:

ID Issuing State:

ID Issue Date :

ID Exp. Date:

Birth Date:

Residential Address:

Residential Address, line 2:

City/State/Zip:

Mailing Address:

City/State/Zip:

Home Phone:

Work Phone:

Cell Phone:

E-mail Address:

Employer:

Occupation:

Password Identifier:

UTMA Custodian

Custodian Name:

SSN/TIN:

Residential Address:

E-mail Address:

City/State/Zip:

Phone:

Work Phone:

Cell Phone:

Pay-on-Death Beneficiaries

Beneficiary #1:

Residential Address:

City/State/Zip:

Mailing Address:

City/State/Zip:

SSN/TIN:

Birth Date:

Relationship to Member:

Beneficiary #2:

Residential Address:

City/State/Zip:

Mailing Address:

City/State/Zip:

SSN/TIN:

Birth Date:

Relationship to Member:

Beneficiary #3:

Residential Address:

City/State/Zip:

Mailing Address:

City/State/Zip:

SSN/TIN:

Birth Date:

Relationship to Member:

Beneficiary #4:

Residential Address:

City/State/Zip:

Mailing Address:

City/State/Zip:

SSN/TIN:

Birth Date:

Relationship to Member:

UTMA Successor Custodian

Custodian Name:

SSN/TIN:

Residential Address:

E-mail Address:

City/State/Zip:

Phone:

Work Phone:

Cell Phone:

TIN Certification and Backup Withholding Information

By signing this document, I certify, under penalties of perjury, that (1) I am a U.S. person (including a U.S. resident alien), (2) the Social Security Number (SSN)/taxpayer identification number (TIN) shown is my/the correct identification number and (3) I am NOT, unless designated below, subject to backup withholding because I have not been notified that I am subject to backup withholding as a result of a failure to report all dividends or interest, or because the IRS has notified me that I am no longer subject to backup withholding. Check below applicable boxes:

I am subject to backup withholding

I am exempt from backup witholding

I am NOT a United States citizen or U.S. person (complete W-8BEN form)

Acknowledgements

Consent to Utilize Credit Report for Additional Services:

Occasionally, Star One Credit Union uses information obtained from an applicant's credit report to evaluate if additional products or services will enhance the financial well-being of the applicant. To enable Star One to provide this valuable service, we have added this disclosure to request your authorization to used information in your credit report to make future credit offers.

I authorize Star One Credit Union to use my credit report for additional loan approvals and in consideration whether to offer other services to me.

For Account and/or Account Service Requests: by signing below, you acknowledge that you have received and agree to the terms and conditions contained in the Membership and Account Agreement, Truth in Savings Disclosure, Funds Availability Policy Disclosure, Electronic Funds Transfer Agreement and Disclosure and Privacy Notice and to any amendments to these documents that the Credit Union may make from time to time.

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

This Membership Application and Account Card must be signed by all account owners. If updates are being made, this will supersede the current Membership Application and Account Card on file.

___________________________________________
Signature

_______________________
Date

___________________________________________
Signature

_______________________
Date

___________________________________________
Signature

_______________________
Date

___________________________________________
Signature

_______________________
Date

Application for Account Held by Trust

Each Trustee agrees to provide an original or certified Trust document as evidence of the Trust's existence. Trustee(s) agrees to complete and sign the Membership Application and Account Card that accompanies this Application for Account Held by Trust:

Trust Agreement and Certification of Trust

Each Trustor/Trustee certifies to the Credit Union the following terms of authority and account conditions:

A valid living Trust has been established under applicable law and currently exists.
At least one Trustor of a Revocable Trust must be a member of the Credit Union. All Trustors or all named beneficiaries of an Irrevocable Trust must be members of the Credit Union.
Trustee agrees to notify the Credit Union in writing of any change in Trustees for the Trust.
The Credit Union is under no obligation to administer the Trust, act as a Trustee, or inquire as to the powers and duties of any Trustee. The Credit Union may, however, withhold payment of funds to any party until satisfactory evidence of authority is produced.
The Credit Union may rely on the authority of any Trustee until it receives written notice of revocation of the Trust or termination of Trustee's authority. The Credit Union may release funds or rely on the direction of any one Trustee acting alone unless the Credit Union agrees in writing that consent of more than one Trustee is required.
The Trust and the Trustees will indemnify and hold the Credit Union harmless from any claim, damage, or loss arising from the unauthorized acts of any Trustee or former Trustee unless a Successor Trustee notifies the Credit Union in writing prior to the unauthorized acts.
All accounts held in the name of the Trust will be governed by this Agreement, the Membership Application and Account Card, and by the terms of the Credit Union's Membership and Account Agreement and Disclosures as amended from time to time. Trustee has received a copy of the Agreement and Disclosures pertaining to the account(s) requested.
If this is a Revocable Trust and the Credit Union receives any garnishment, levy, or other form of execution against the Trustor(s), or if the Trustor(s) owes money to the Credit Union, the Credit Union may treat all accounts held by or on behalf of the Trust as if they were held by the Trustor(s) individually.
THIS AGREEMENT AFFECTS YOUR LEGAL RIGHTS. IF YOU DESIRE ASSISTANCE OR ADVICE CONCERNING THIS AGREEMENT, YOU SHOULD SEEK THE ADVICE OF AN ATTORNEY OR OTHER PROFESSIONAL PERSON. THE CREDIT UNION CANNOT GIVE LEGAL ADVICE REGARDING EITHER THIS AGREEMENT OR THE TRUST.

Member number ,

Name of Trust

Date of Trust

SSN / TIN

Trustor Name

Trustee Name

Successor Trustee(s)

Residential Address

Residential Address, line 2

City/State/Zip

Home Phone

Work Phone

Beneficiary #1

SSN

Relationship

Beneficiary #2

SSN

Relationship

Beneficiary #3

SSN

Relationship

Beneficiary information is not required; however, failure to provide such information may disqualify the account from additional NCUSIF share insurance available for multiple beneficiary accounts.

"I declare under penalty of perjury and as provided under the California Trust Law, Division 9, Section 18100.5 of the California Probate Code, that (1) I am a trustor/Trustee of the Trust and the Trust is currently in full force and effect; (2) I am authorized to transact business with Star One Credit Union on behalf of the Trust; (3) I am qualified and have the power to act and am properly exercising the powers under the Trust; (4) the foregoing statements are true and correct and the Trust has not been revoked, modified or amended in any manner that would cause any representation contained in this Trust Agreement or Certification of Trust to be incorrect; and (5) this Trust Agreement and Certification of Trust is being signed by all of the Trustor(s) and currently acting Trustee(s) of the Trust."

___________________________________________
Trustor Signature
_______________________
Date

___________________________________________
Trustee Signature
_______________________
Date

Star One Credit Union use only

Opened by (Operator ID & initials):

Date:

Rev: 2/22/2019