Moya Membership Application - AYA Clients

Personal (Member) Application

For Bank Accounts and Term Deposits
- Select the type of account
- How would you like to receive statements
- In case of Joint Account who will be Signing Authority
- Enter Name of the Second Signing Authority
- Title
- Name
  
  First NameLast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityProvince
  
  Postal CodeCountry
- At Current address since
  
  MonthDayYear
  Date
- SIN
  Social Insurance No
- Email
  example@example.com
- Date of Birth
  
  MonthDayYear
  MM/DD/YYYY Birth Date
- Employer Name
- Occupation (Role / Title)
  Doctor, Teacher, Manager, Etc
- Employment Type
  Industry: Financial Services, Healthcare, Engineering, etc
- Employer Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Employer Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Employment Date
  
  MonthDayYear
  Date
- Personal Phone
  Format: (000) 000-0000.
- Work Phone
  Format: (000) 000-0000.
- Identification #1 (must be a photo ID)
- Document Type
- Reference Number
  ID Reference #
- Issue Date
  
  MonthDayYear
  Date
- Expiry Date
  
  MonthDayYear
  Date
- Province
  Ie: Toronto, Canada
- Country of Issue
- Identification #2
- Document Type
- Reference Number
  ID Reference #
- Issue Date
  
  MonthDayYear
  Date
- Expiry Date
  
  MonthDayYear
  Date
- Province
  Ie: Toronto, Canada
- Country of Issue
- Declarations
- Are you a Canadian Resident?
- Politically Exposed Person (PEP) Declaration
- Do you give us consent to receive Marketing Communication
- FATCA/CRS Declaration: By submitting this application, you certify that have provided the financial institution with a FATCA/CRS declaration form that is satisfactory to the Financial Institution. You agree to inform the Financial institution if your tax residency changes
- Do you want a Debit Card
- Online Banking
- Purpose of Account
- Source of Funds
- Consent for Full Personal Credit Report
- Initials For Applicant
  Your initials, ie. For Mustafa Khan type MK
- Signature for Applicant
- Witness
- New Member
- Date
  
  MonthDayYear
  Date
- Title
- Name
  
  First NameLast Name
- Co-applicant Address
  
  Street Address
  
  Street Address Line 2
  
  CityProvince
  
  Postal CodeCountry
- Resident Since
  
  MonthDayYear
  Date
- Co Applicant SIN Number
  Social Insurance No
- Date of Birth (2)
  
  MonthDayYear
  Birth Date
- Co-applicant Email
  example@example.com
- Co-applicant Employer Name
- Occupation (Role / Title)
  Doctor, Teacher, Manager, Etc
- Employment Type
  Industry: Financial Services, Healthcare, Engineering, etc
- Employer Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Employer Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Effective Employment Date
  
  MonthDayYear
  Date
- Personal Phone
  Format: (000) 000-0000.
- Work Phone
  Format: (000) 000-0000.
- Document Type
- Reference Number
  ID Reference #
- Issue Date
  
  MonthDayYear
  Date
- Expiry Date
  
  MonthDayYear
  Date
- Province of Issue
  Ie: Toronto, Canada
- Country of Issue
- Document Type
- Reference Number
  ID Reference #
- Issue Date
  
  MonthDayYear
  Date
- Expiry Date
  
  MonthDayYear
  Date
- Province of Issue
  Ie: Toronto, Canada
- Country of Issue
- Declarations
- Are you a Canadian Resident?
- Politically Exposed Person (PEP) Declaration
- Do you give us consent to receive Marketing Communication
- FATCA/CRS Declaration: By submitting this application, you certify that have provided the financial institution with a FATCA/CRS declaration form that is satisfactory to the Financial Institution. You agree to inform the Financial institution if your tax residency changes
- Do you want a Debit Card
- Online Banking
- Purpose of Account
- Source of Funds
- Consent for Full Personal Credit Report
- Initials For Co-Applicant
  Your initials, ie. For Mustafa Khan type MK
- Signature For Co-Applicant
- TERM DEPOSIT DETAILS – SHARIAH COMPLIANT
- Amount (the “Principal”)
  Amount you will deposit into your halal bank account
- Type of Deposit Product / Account
- DISCLAIMER AND TERMS & CONDITIONS
- - A Representative will be in contact with you to confirm the details of your submission with respective terms prior to any initialization of the deposit.
  - Do not worry, we will not initiate the transfer till one of our representatives are in touch with you.
  - Thank you for your submission and we will be in touch.
- ID # 1 - File Upload
  
  Attach your 1st ID
  Cancelof
- ID # 2 - File Upload
  
  Attach your 2nd ID
  Cancelof
- Other - File Upload
  
  Any other information you wish to share
  Cancelof
Should be Empty:

Personal (Member) Application

Declarations

Declarations

TERM DEPOSIT DETAILS – SHARIAH COMPLIANT

DISCLAIMER AND TERMS & CONDITIONS