Membership Application

The field of membership of Luso Federal Credit Union (LFCU) applies to those individuals having the following common bond:

- Persons who live, work, worship, or attend school in, and businesses or other legal entities located throughout Hampden County, Massachusetts.

- Members of record of this Credit Union as of October 6, 1998, the date of conversion to community charter.

- And also included are spouses of current members or members who have died while within the field of membership of this Credit Union, employees of this Credit Union, members of their immediate families, and organizations of such persons.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the 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 who opens an account.

This means that when you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. This is a secure form.

HOW DO YOU QUALIFY FOR MEMBERSHIP?

Related to Luso Federal Credit Union Member

I live in Hampden County, Massachusetts.
City/Town:

I work in Hampden County, Massachusetts.
Institution Name:

I worship in Hampden County, Massachusetts.
Church/Organization Name:

I attend school in Hampden County, Massachusetts.
Name of School:

This account is for a business or legal entity located in Hampden County, Massachusetts.
Name of business or legal entity:

MEMBERSHIP TYPE

* Please choose your membership type.

APPLICANT

* First Name:

* Middle Initial:

* Last Name:

* Street Address:

* City:

* State:

* Zip Code:

* Social Security Number/FID:

* Driver's License Number:

* Driver's License State:

* Date of Birth:

* Home Phone:

* Work Phone:

* Cell Phone:

* Mother's Maiden Name:

* Email Address:

CO-APPLICANT

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Social Security Number/FID:

Driver's License Number:

Driver's License State:

Date of Birth:

Home Phone:

Work Phone:

Cell Phone:

Mother's Maiden Name:

Email Address:

IN ADDITION TO MY NEW SHARE ACCOUNT, PLEASE OPEN THE FOLLOWING:

Additional accounts:

ACCOUNT AGREEMENT

* I hereby apply for membership at Luso Federal Credit Union and agree to conform to its bylaws and amendments thereof and subscribe for at least one share. I accept all the terms and conditions of this account agreement and agree to receive all applicable disclosure(s) and rate and fee schedules electronically or by mail.

I agree to these terms and conditions

TAX ID NUMBER CERTIFICATION

* Under penalties of perjury, I certify:

1. That the number shown above is my correct taxpayer identification number and;

2. That I am not subject to backup withholding, either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding.

3. I am a U.S. person (including a U.S. resident alien).

IMPORTANT TAX INFORMATION

You (as the payee) are required by law to provide us (as payer) with your correct taxpayer identification number. If you are an individual, your taxpayer identification number is your Social Security number. If you are acting on behalf of a business, the taxpayer identification number is the Federal Identification number. If you have not provided us with your correct identification number, you may be subject to a $50 penalty imposed by the Internal Revenue Service. In addition, interest dividends and other payments that we make to you may be subject to backup withholding.

Backup withholding is different from the 10 percent withholding on interest and dividends that was repealed in 1983. If backup withholding applies, a payer is required to withhold 31 percent of interest, dividends, and other payments made by you. Backup withholding is not an additional tax. Rather the tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If withholding results in an overpayment of taxes, a refund may be obtained.

Before you can join the Credit Union, you must acknowledge that you have successfully completed the Tax Identification portion of this agreement.

I agree to these terms and conditions

PAYABLE ON DEATH ACCOUNT AGREEMENT (MULTIPLE PERSONS)

* Luso Federal Credit Union is hereby authorized and agrees to recognize any of the names subscribed hereto below in the payment of funds or the transaction of any business for this account. The individuals named to this account shall be joint owners during their lifetime and agree with each other and the Credit Union that all sums now paid in on shares, or heretofore or hereafter paid in on shares by any or all of said joint owners to their credit as such joint owners with all accumulations thereon, together with the proceeds of any insurance on said account, are and shall be owned by them jointly with right of survivorship and be subject to the withdrawal or receipt of any of them, and payment to any of them or the survivor shall be valid and discharge the Credit Union from any liability for such payment. The right or authority of the Credit Union under this agreement shall not be changed or terminated by said owners, or any of them except by written notice to and consent of the Credit Union which shall not affect transactions made prior to receipt thereof. Any or all of said joint owners may pledge all or any part of the shares in this account as collateral security to a loan or loans.

I agree to these terms and conditions

Name of Joint Owner:

Social Security Number:

Name of Joint Owner:

Social Security Number:

Name of Joint Owner:

Social Security Number:

Name of Joint Owner:

Social Security Number:

PAYABLE ON DEATH PAYEE

Luso Federal Credit Union further agrees to the following person upon request all amounts, including accumulations and the proceeds of any insurance on said account, after death of all of the above named individuals.

* Indicates Response Required

Individual Account	Trust Account
Joint Account with Survivorship	Joint Account without Survivorship
Payable on Death (POD)	Custodian Under Uniform Gift to Minors Act
Other (explain)

Classic Share Draft Checking	REWARDS Share Draft Checking
Preferred Share Share Draft Checking	60 Plus Share Draft Checking
Secure Share Draft Checking	Advantage Statement Share Savings
Solar Statement Share Savings	NOW Money Market Account
Term Share Certificate/IRA	SAVINGS IS FUN Share Account
L-U-S-O Share Account	Business Share Draft
Small Business Share Draft	DBA Share Draft
Business Money Market	Other Investment Opportunities
Club Account: