Greater Pittsburgh Federal Credit Union

4415 Fifth Ave, Suite 100 Pittsburgh, PA 15213 P: 412-621-6800 F: 412-681-7421

www.greaterpittsburghfcu.org

Remove Joint Owner Form

Primary Owner Information

Account Number: ______________________________ Email Address:___________________________________________________

First Name: __________________________________________________________________________ Middle Initial: ____________

Last Name: ____________________________________________________Maiden Name (if applicable): ___________________________

Street Address: _______________________________________________________________________________________________

City: __________________________________________________ State:______________ Zip Code: __________________________

Home Phone: _________________________ Work Phone: _________________________ Cell Phone:_________________________

Joint Owner to Remove (If the joint owner will not be present at the credit union when removed from account, a notary authorization is required.)

Joint Owner First Name: ______________________________________ Email Address: _____________________________________

Last Name: _________________________________________________ Maiden Name (if applicable): _____________________________

Social Security Number: _________________________________________ Date of Birth: ___________________________________

Date of Death (Certified Certificate Required):___________________________ Suffix Removed From: ___________________________________

Joint Owner Disclosure

My signature below acknowledges a release of all my rights, title, and interest in the account listed above as of the date of my signature, and I hereby agree to indemnify, defend, and hold harmless Greater Pittsburgh Federal Credit Union and its directors, officers, employees and agents from and against any and all losses, damages, causes of action or other claims relating to or arising out of the account identified herein, including any and all actions and inactions that the credit union and/or other joint owner on such account may have taken in the past or may take the future in relation to such account. This release of my rights, title, and interest in the account does not affect my obligation to any outstanding loans on this account and does not affect my obligation on any account other than the account specifically identified herein.

Joint Signature Authorization: _________________________________________________ Date: ___________________

Notary Authorization (If the joint owner will not be present at the credit union when removed from account, a notary authorization is required).

I, ________________________________, agree to the removal of my name as Joint Owner on the above account(s) with GPFCU.

(Print Joint Owner Name)

Joint Owner’s Signature: ________________________________________________ Date:_______________________

On________________ before me, _______________________________________________, Notary Public, personally known to

(Date)

(Notary)

be (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her signature on the instrument. WITNESS by my hand and official seal.

Signature: _____________________________________________ My commission expires _____________

(Notary Stamp Here)

(Notary Signature)

 

Primary Owner Disclosure

By signing below, I acknowledge and agree that I am responsible for the custody and control of ALL checks and/or VISA debit/credit cards associated with this account and I am responsible for establishing and subsequently changing all Passwords, Security Questions, and Security Codes associated with Telephone and Online Banking Services associated with the account. I further acknowledge that as the primary account holder on this joint account, Greater Pittsburgh Federal Credit Union shall have no liability to me in the event that the joint owner is removed from the account and that I shall be responsible for any and all then pending transactions (i.e., pending at the time the joint owner removes himself or herself from the account) which have not yet posted to the account, for collecting all ATM/debit card issued to any other joint owner, and/or for closing out the joint account and establishing a new single member account, if I so desire. I hereby agree to indemnify, defend and hold harmless Greater Pittsburgh Federal Credit Union and its directors, officers, employees, and agents from and against inaction taken on the account by such other joint owner after the date on which such owner removes himself or herself from the account.

Primary Signature Authorization:______________________________________________________Date:_______________________

For Credit Union Use Only

All debit cards closed

Reorder debit cards

Updated Account Information

Completed By: ____________________________________________________________________________________