Credit Union

I HOLDER OF PASSBOOK# OF HEREBY NOMINATE

NOMINEE’S NAME: PASSBOOK#

ADDRESS:

TO CONTEST FOR THE OFFICE OF (PLEASE TICK APPROPRIATE BLOCK )

BOARD OF DIRECTORS MEMBER

CREDIT COMMITTEE MEMBER

SUPERVISORY COMMITTEE MEMBER

SECONDED BY: PASSBOOK#

ADDRESS:

I, HOLDER OF PASSBOOK# OF

HEREBY ACCEPTS NOMINATION AS STATED ABOVE

NOMINATOR’S SIGNATURE:

SECONDER’S SIGNATURE:

NOMINEE’S SIGNATURE:

DATED THIS DAY OF IN THE YEAR OF OUR LORD

SIGNATURE-SECRETARY-BOARD OF DIRECTORS:

NOMINATION FORM 2023