Registration form

Members Initials & Surname:Membership Number:
Telephone Number (h):


Title/ Full Name of Beneficiary (as per ID Document)


% Share of Benefit

ID Number


IMPORTANT NOTES: 1. Please note that the nominated beneficiary(ies) inherit the proceeds of the shareholding and/or savings on death of the member. 2. Please show the percentage share of benefit in which the proceeds must be distributed to each of the beneficiaries nominated. 3. Please provide full identity numbers of beneficiaries as this will avoid any misunderstanding at claims stage. 4. Should there be no surviving beneficiary at the date of the members’ death, the monies will be paid into the members’ estate, unless otherwise indicated. 5. Should there be more than one surviving beneficiary at the date of the member’s death, the predeceased beneficiaries’ share shall be payable to the surviving beneficiaries in a ratio governed by their original proportions, unless otherwise indicated. SEND THE COMPLETED FORM TO YWBN CO-OPERATIVE BANK BY: E-mail

By submitting this form indicated that I do hereby designate the beneficiary the said beneficiary the said persentage of shares.