* Indicates Required Field
The undersigned and Illiana Financial Credit Union hereby agree that the subject account and any balance therein which exists from time to time shall be held as a Payable on Death Account and that, upon the death of the undersigned, the account shall be payable to and owned by the following designated person(s).
A. CHECKING AGREEMENT: I/we have read and hereby accept the Checking Account Agreement noted on the reverse of this brochure.
B. CERTIFICATION: Under penalties of perjury, I certify that (1) the number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and (2) I am not subject to backup withholding either because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest, or (c) the IRS has notified me that I am no longer subject to backup withholding.
Certification Instructions: You must let us know in the additional details area (2) if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest on your tax return. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
The undersigned and Illiana Financial Credit Union further agree that: