Membership Application Form – Tip Friendly Society

OVERVIEW

Welcome to the TIP Friendly Society Membership Application.

Please complete all sections of this form accurately, using BLOCK CAPITAL LETTERS where applicable. Before you begin, ensure you have all required supporting documents ready for upload. Files must be clear and submitted in PDF, JPG, or PNG format.

Membership becomes active once the first premium and permanent share purchase are received. False or misleading information may result in the rejection of your application or cancellation of coverage.

Applicants requesting name changes must upload legal proof, and any applicant listing minors as beneficiaries must appoint a trustee. Coverage terminates at retirement or at age 70, whichever comes first, with Group Life reducing by 50% at age 65.

The following supporting documentation is Mandatory for ALL NEW MEMBERS:

1.Valid Identification (Government-issued)
2. TRN (Tax Registration Number) – if not shown on ID
3. Proof of Address – if address differs from ID
4. Recent Pay Slip OR Employment Letter
5. Signed Salary Deduction Authorization Form (Page 4)
6. Signed Data Privacy Consent Form (Pages 5–6)

MEMBER INFORMATION

Member Number:

Payment Source

Ministry of Education

Bursar

Gender

Title

First Name

Middle Name

Last Name

Maiden Name

Date Of Birth

TRN Do not enter dashes

Number of Dependents

*Email

Ages of Dependents

*Phone Number

Phone Number 2

Address of Current ResidenceStreet

Parish

Mailing addresst if different from above *Street

SPOUSE / NEXT OF KIN INFORMATION

Gender

Title

First Name

Middle Name

Last Name

Maiden Name

Date Of Birth

TRN Do not enter dashes

Address of Current ResidenceStreet

*Phone Number

*Email

SPOUSE EMPLOYMENT INFORMATION

Institution Code:

Occupation of Applicant

*Company Name

Annual Salary

Lenght of Employment

Employment Status

Work Address

Phone Number

INSTRUCTIONS (ONLY IF INCLUDED FOR COVERAGE)

Maximum of 6 persons (including the applicant, spouse, children & any combination of up to 2 persons of member's parents or parents-in-law).

Sign-up required before age 55 for TIP Member, below age 75 for spouse, parents and parents-in law, and before age 18 for children. No Member shall receive more than 2 adult dependent death benefits..

ENTER NAMES, DATES OF BIRTH AND RELATIONSHIP

Name

Date of Birth

Relationship

Name

Date of Birth

Relationship

Name

Date of Birth

Relationship

Name

Date of Birth

Relationship

Name

Date of Birth

Relationship

Name

Date of Birth

Relationship

ENTER NAMES, DATES OF BIRTH AND RELATIONSHIP (ONLY IF INCLUDED FOR COVERAGE)

Please state beneficiaries who will be entitled to the benefits in the event of death of the Insured. PLEASE BE ADVISED THAT MINORS (UNDER THE AGE OF 18)

STATED AS BENEFICIARIES, MUST BE APPOINTED A TRUSTEE. THIS TRUSTEE APPOINTMENT WILL REMAIN IN EFFECT UNTIL THE MINOR ATTAINS AGE 18.

BENEFICIARY #1

Full Name Of Beneficiary

Relationship to Member

% Designation for Beneficiary

Date of Birth of Beneficiary

*Phone Number

Full Name Of Trustee (if beneficiary is a minor)

Relationship of Trustee to Minor

Date of Birth of Trustee

*Trustee Phone Number

*Email of Trustee

BENEFICIARY #2

Full Name Of Beneficiary

Relationship to Member

% Designation for Beneficiary

Date of Birth of Beneficiary

*Phone Number

Full Name Of Trustee (if beneficiary is a minor)

Relationship of Trustee to Minor

Date of Birth of Trustee

*Trustee Phone Number

*Email of Trustee

BENEFICIARY #3

Full Name Of Beneficiary

Relationship to Member

% Designation for Beneficiary

Date of Birth of Beneficiary

*Phone Number

Full Name Of Trustee (if beneficiary is a minor)

Relationship of Trustee to Minor

Date of Birth of Trustee

*Trustee Phone Number

*Email of Trustee

BENEFICIARY #4

Full Name Of Beneficiary

Relationship to Member

% Designation for Beneficiary

Date of Birth of Beneficiary

*Phone Number

Full Name Of Trustee (if beneficiary is a minor)

Relationship of Trustee to Minor

Date of Birth of Trustee

*Trustee Phone Number

*Email of Trustee

BENEFICIARY #5

Full Name Of Beneficiary

Relationship to Member

% Designation for Beneficiary

Date of Birth of Beneficiary

*Phone Number

Full Name Of Trustee (if beneficiary is a minor)

Relationship of Trustee to Minor

Date of Birth of Trustee

*Trustee Phone Number

*Email of Trustee

Please choose your preferred method of certificate delivery (choose one)

Mail to home address

Mail to work address

Hand delivery

Other Method of Delivery:

Premium Payments Allocation Authorization

IMPORTANT: Please indicate here how the monthly salary deduction should be allocated

Insurance Products (Personal Accident & Group Life)

TIP Basic Plan

TIP Super Club

TIP for Life

TIP Kids Benefit

Spouse’s Insurance

TIP Family Protector Option 1

TIP Family Protector Option 2

TIP Family Protector Option 3

INSURANCE PRODUCTS TOTAL

COMMENTS

Saving Products

TIP Accumulator

TIP Pool Fund

TIP Grad Club

TIP Educator

TIP Partner Club

TIP Compulsory Savings

TIP for Wealth

Other

SAVINGS PRODUCTS TOTAL

Loans Repayments

TIP Regular Loan

TIP Education Loan

TIP Express Loan

TIP Partner Club Loan

TIP Auto Loan

TIP Debt Consolidation Loan

TIP Vacation Loan

Other Loan

Loan Repayments Total

TOTAL MONTHLY DEDUCTION

DISCLAIMER AND SIGNATURE

I hereby apply for membership in TIP Friendly Society, and agree to participate in the Income Protector/Savings/Loans programme operated by the Society according to the terms and conditions that have been outlined. I declare that all statements/answers in this application are true and complete to the best of my knowledge and belief. I affirm the good health of myself and proposed dependents. I understand that false or misleading information/answers will lead to the cancellation of this application and/or policy.

I do agree to abide by the Policies, Rules and Regulations governing the Society and its modus operandi and will conform to the Rules and Amendments of the Society. As a new member, I am aware that the amount of $2,000 for the purchase of permanent shares will be satisfied first before any of the membership benefits are applicable to me. I am aware that this programme is not in effect until the stated premium is received.

I authorize TIP Friendly Society to deduct my monthly premium/loan payment from my account if my employer fails to remit same.

I declare that all statements/answers in this application are true and complete to the best of my knowledge and belief. I affirm the good health of myself and proposed dependents. I understand that false or misleading information/answers will lead to the cancellation of this application and/or policy. I do agree to abide by the Policies, Rules and Regulations governing the Society and its modus operandi and will conform to the Rules and Amendments of the Society.

Applicant's Name

Applicant's Signature

Date