Membership application form
To be eligible to join the Credit Union, you need to be aged 16 or over.

Please note that this process is not a 'real time' transaction and that there will be a short delay between your submission and the application being processed within the credit union office.

  • ALL fields marked with an "*" are mandatory and you must enter/select the appropriate information.
PERSONAL details:
Title: *
Forename: *
Middle name(s):
Surname: *
Household status: *
Home address House number or:
  Flat number:
  Street *
  Town *
  Postcode: *
When did you start living here: / /
Sex: *
Date of birth: / / * (Age: )
National insurance number: *
Ethnicity: *
E-mail: *
Home telephone: *
Mobile telephone:
Do you pay tax outside of the United Kingdom ? *
ID verification methods:
You have been asked for your Driving Licence and/or Passport Number to enable automatic electronic ID verification. If you are unable to provide these details you may be contacted to provide more information before your membership is confirmed.
Driving licence number
Passport number
Work details:
Employment status: *
Beneficiary details:
(This is the person you nominate to receive your savings on your death)
Beneficiary name:
Relationship to you:
Beneficiarys address: House/Flat No and street name:
Beneficiarys contact number:
Banking details
Sort code:
Account number:
Building society roll number: (if applicable)
Name on account:
Additional information
I * wish to receive annual statements from the credit union via email. Statements not sent via email will be sent via post.
I * wish to receive promotional information from the credit union via email.


This credit union will process your data in accordance with your rights under the Data Protection Act 1998 and GDPR 2018. Your information may processed by this credit union in any form and on any database used by us to consider any applications made by you and to deal with your account(s) or run any other services we provide to you. Black Squirrel will periodically send you a newsletter, statement message, new terms and conditions or information about any changes to the way your account(s) operate. We may share data with regulatory, law enforcement or fraud prevention bodies to undertake statistical analysis, money laundering checks, compliance and regulatory reporting and fraud prevention. We may also share with credit reference agencies for financial risk assessment or with suppliers for the provision of third party services such as payment services or pre-paid cards. We will always ensure that your information is shared lawfully.

The legal basis for processing your personal data can be found in our Privacy Statement available online at A paper copy of our Privacy statement is available on request.

Your consent is required to send you information about our products and services by electronic means. Please tick this box if you consent to receiving marketing information in this way.

I * to abide by the rules of the Credit Union and declare that the information given by me on this form is true and correct to the best of my knowledge and belief.

By submitting this form, you are agreeing to an online ID check. This is not a credit check.

Click here to download a copy of the FSCS Information Sheet.
Further copies can be requested at any time by contacting

I have read the above FSCS Information Sheet and downloaded a copy for future reference. * ( please tick to confirm )
Human verification