United Nations Federal Credit Union
Court Square Place, 24-01 44th Road
Long Island City, NY 11101-4605
T: +1 347-686-6000 | F: +1 347-686-6400
[email protected] | www.unfcu.org
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CUSTODIAL ACCOUNT (FOR MINORS 0-17):
This Custodial Account is governed by and established in accordance with the New York State Uniform Transfers to Minors Act. The role of
a custodian is to control the funds in the account for the benefit of the minor. A Custodial Account may be retitled by the custodian or the
minor when the minor reaches the age of 21. If the minor has reached the age of 18, but is younger than 21, the consent of the custodian
is required to retitle the account. This type of custodial account is a savings account.
A. Minor’s Information
___________________________________________________________________________________________________________________________
Minor’s Relationship to Custodian
_______________________________________ ________________________________________ ________________________________________
Minor’s Name (Last)
(First)
(Middle)
_______________________________________ ________________________________________ ________________________________________
Minor’s US Social Security/Identification Number
(if applicable)
Country of Citizenship
Birth Date (DD Mon YYYY)
_________________________________________________________________________________ ________________________________________
Minor’s Address (Street & Number)
Apt. Number
_____________________________ _____________________________ _____________________________ _____________________________
City State/Province
Zip/Postal Code
Country
____________________________________________________________ _____________________________________________________________
Email Address (if applicable)
Phone Number
B. Custodian Information
____________________________________________________________
Member Number
_______________________________________ ________________________________________ ________________________________________
Custodian Name (Last)
(First)
(Middle)
_______________________________________ ________________________________________ ________________________________________
Custodian US Social Security Number
Country of Citizenship
Birth Date (DD Mon YYYY)
_________________________________________________________________________________ ________________________________________
Custodian Address (Street & Number)
Apt. Number
_____________________________ _____________________________ _____________________________ _____________________________
City State/Province
Zip/Postal Code
Country
____________________________________________________________ _____________________________________________________________
Email Address (if applicable)
UNFCU | serving the people who serve the world
Phone Number
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C. Successor Custodian Custodial Account Only
A successor custodian may be appointed in accordance with the New York State Uniform Transfer to Minors Act. Upon the resignation,
removal, death or incapacity of the custodian, the successor is appointed to perform their duties until the minor is the age of 21. The
successor custodian must be eligible for UNFCU membership and become a member of UNFCU prior to commencing custodial duties on
the account.
___________________________________________________________________________________________________________________________
Name of Successor Custodian
_______________________________________ ________________________________________
Relationship to Minor Successor Custodian Date of Birth (DD Mon YYYY)
___________________________________________________________________________________________________________________________
Successor Custodian Address
____________________________________________________________ _____________________________________________________________
Email Address (if applicable)
Phone Number
D. Tax Certification (For Custodian to complete and sign)
For Non-US Persons:
If I am a nonresident alien, I am required to complete the appropriate Form W-8 to certify my foreign status.
For US Persons:
If I am a US Citizen or a representative of a US entity or individual, I certify under penalties of perjury that: the tax identification number
shown on this form is correct and I am not subject to backup withholding 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 failure to report all interest
and dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.
If I am a nonresident alien, I am required to complete the appropriate Form W-8 to certify my foreign status. I understand that I am not
under penalties of perjury certifying the above information.
x______________________________________ ________________________________________ ________________________________________
Signature of Custodian
UNFCU | serving the people who serve the world
Minor Name Date (DD Mon YYYY)
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E. Account Agreement for Custodial Account
Custodial Accounts and Duties
By applying for a custodial account with UNFCU, I acknowledge that this account will be governed by the New York State Uniform Transfer
to Minors Act (“UTMA”) and agree to act as custodian for the minor named herein and comply with the UTMA and any amendments
thereof. All funds deposited in the account irrevocably become the property of the minor, but are to be managed for the minor’s benefit by
the custodian. Only one custodian (who must be 21 or older) and one minor are allowed per account. Contact your attorney or other advisor
for advice regarding the legal, tax, investment and/or estate planning implications of an UTMA custodial account.
I hereby acknowledge receipt of the UNFCU Disclosures and Agreements (“Account Disclosures”) which outline all the terms and
conditions associated with my account at UNFCU. I have read and understand all the material outlined in the Account Disclosures and
agree to be bound by the same.
Under penalties of perjury, the custodian certifies (1) that the number shown on this form is the minor’s correct taxpayer identification
number and (2) that the minor is not subject to backup withholding as a result of a failure to report all interest dividends, or the Internal
Revenue Service has notified the custodian that the minor is no longer subject to backup withholding.
It is the intent of the custodian to retitle the custodial account to the minor when he/she achieves the age of 21 or, at custodian’s election,
18. If the custodian does not retitle the account to the minor upon their reaching the age of 21, UNFCU may freeze all account activity until
the time such retitling occurs.
x________________________________________________________________________________ ________________________________________
Signature of Custodian
Date (DD Mon YYYY)
10/2016
APPROVED 
YES OFFICE USE ONLY

NO
___________________________ _____________________________ _____________________________ ___________________________
Member Number Date (DD Mon YYYY)
Membership Agreement Number MSR Signature
x________________________________________________________________________________________ Reviewer Signature
UNFCU | serving the people who serve the world
__________________________
Date (DD Mon YYYY)
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