INTEREST AND DIVIDEND TRANSFER REQUEST FORM

Name of Member

Account Information

Select branch: Browns TownKingstonLinsteadMandevilleMay PenMontego BayMorant BayPortmorePort AntonioPort MariaSanta CruzSavanna-la-Mar

Date of Birth

Address

Contact Information

ID Information
Proof of Address

ID

Select ID Type
PassportDriver's LicenseVoter's ID
TRN

I hereby request a transfer of my 2019 Interest & Dividend from my Shares to my Easi Access Savings Account.

By submitting your name on this form, you have authorized JTACCUL to accept this as your consent and intent to sign electronically.