New Membership Application - Assurance Cooperative

I consent to Assurance Cooperative having my submitted information so that they can process my application to become a member. *

Consent

First Name *

Middle Name

Last Name *

Gender *

Date of Birth *

Email *

Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Next of Kin Information

First Name – Next of Kin *

Last Name – Next of Kin *

Phone- Next of Kin *

Relationship to selected Next of Kin *

Signature to confirm that the demographics above are accurate and voluntarily submitted *

I agree that typing my full name in the box above is the equivalent of signing a physical paper document. I authorize AIC to treat this as my consent to treat it as such.

ASSURANCE COOPERATIVE SUBSCRIPTION AGREEMENT

I, the, aforesigned individual, with the name and address above, attest that I am an adult of legal age.

I hereby voluntarily attest and declare:

1. That I have voluntarily manifested my intention to be admitted as a member of ASSURANCE INVESTMENT AND CO-OPERATIVE INC (AIC), a multi-purpose investment cooperative organized and existing under State of California Under the Nonprofit Mutual Benefit Corporation Law of California which became effective as of January 1, 1984, (Sections 12200 through 12704 of the California Corporations Code). by complying with the minimum requirements of membership and submitting all documentary requirements, among others, thereto.

2. That AIC has made known and explained fully my rights and obligations of membership in this cooperative as provided by the amended AIC Articles of Cooperation and Bylaws.

3. That one of my obligations as a member in AIC is my faithful contribution and/or payment for the minimum subscribed.

4. That I hereby voluntarily commit to pay fully the total subscription as at and when due.

5. That I also undertake to comply with the mandate on continuous capital build-up as provided and agreed upon by the general house, particularly on the regular payment of minimum subscribed payment. I voluntarily agree to pay monthly subscriptions every month, which shall be credited in my share capital in the cooperative.

6. That I fully understand that my utter failure to pay the said minimum application, entry and monthly subscriptions affects my membership status in AIC that is, I will NOT be considered as a member in good standing and as such, I am NOT entitled to vote therein.

7. The contribution of a member in any investment over and above all other members individual contributions shall not give the member more rights and/ or privileges over other members.

8. No member is allowed to borrow from the cooperative until at least 6 months have elapsed from the initialization of the member’s membership.

9. Any member who wishes to borrow an amount more than the money the member has hitherto contributed into AIC will be required to provide at least two other members as guarantors. These guarantors’ contributions shall subsequently be held against the amount being borrowed by the borrower.

10. If you desire to liquidate your membership. Refund shall be at a 5% fee including application fee, initial entry fee and any other amount as may be necessary.

11. You agree to be committed to the rules and byelaws of AIC and you are to regularly attend the scheduled meetings.

IN WITNESS WHEREOF, I certify that my answers are true and complete to the best of my knowledge.

I understand that false or misleading information in my application or interview may result in my release.

Signature *

I agree that typing my full name in the box above is the equivalent of signing a physical paper document of this agreement. I authorize AIC to treat this as my unreserved consent to treat it as such.

Signed this day, at San Diego County, California *

Date

Time

Administrative and Commitment Information

I have read and agree to the terms above. I understand the that the following are my next steps: *

Payment of an application/onboarding/administrative fee of $100. (Please note that this $100 fee is payable once per annum per member)
I am expected to immediately also make payment of my monthly dues (minimum $50).

Monthly dues can be $50, $100, $200, $300 or $400. Your chosen monthly dues must be made at the same time as your administrative and application fee ($100). This means that if your chosen monthly dues is $50, then your first payment will be a minimum of $150 comprising of your application/administrative fee and 1 month’s monthly dues.

Zelle Phone Number – 619 -439 – 5151

Bank Information- Please be sure to forward your initial and subsequent monthly payment(s) to the following account belonging to Assurance Cooperative.

Account Number: 3251 7901 8417

Routing Number: 121 000 358

Account Name: ASSURANCE INVESTMENT AND COOPERATIVE INC.