Annex 1
Application for approval of use of words ‘Credit Union’ in name
Under Section 3 of the Credit Unions Act 1979
Full name of applicant firm for which approval is sought
approval of use of words “Cre
Union” in name
Important information you should read before completing this form
Under Section 3 of the Credit Unions Act 1979
Please keep a copy of your form for future reference.
Please be aware that any personal details you give on the form will be placed on the credit union’s
public file.
It is important that you provide accurate and complete information and disclose all relevant
information. If you do not, it may increase the time taken to assess your application.
Terms in this form
In this form we use the following terms:
 'we', ‘us’ or 'our' refers to the appropriate regulator;
 ‘the FCA’ refers to the Financial Conduct Authority;
 ‘the PRA’ refers to the Prudential Regulation Authority;
 'the applicant firm' refers to the firm applying for registration and authorisation; and
 'you' refers the person(s) signing the form on behalf of the applicant firm.
Filling in the form
1 If you are using your computer to complete the form:

use the TAB key to move from Question to Question and press SHIFT TAB to move back to the previous
Question; and

print out all completed form and arrange for it to be signed.
2 If you are filling in the form by hand:

use black ink;

write clearly; and

sign the declaration in the 'declaration' Section.
3 If you
 leave a Question blank; or
 do not sign the declaration; or
 do not attach the required supporting information without telling us why
we will have to treat the application as incomplete. This will increase the time taken to assess your application.
4 If there is not enough space on the forms, you may need to use separate sheets of paper. Clearly mark each
separate sheet of paper with the relevant Question number.
5 Post this form to us at:
The Financial Conduct Authority
25 The North Colonnade
LONDON
PRA/FCA  Application for approval of use of words credit union in name  Release 1 April 2013
E14 5HS
page 1
1 Details of applicant firm
1
Details of applicant firm
1.1 Address
Address
Postcode
Phone number (including STD code)
Email address
1.2 Tick whichever of the following applies:
Pre-registration study group
Association / grouping of Credit Unions
Credit Union Development Agency
Specialist supplier of services to credit unions
Friends of xyz Credit UnionYou must also complete Annex 1
1.3 Give more details about the applicant’s activities
1.4 Give reasons to support this application for approval (if appropriate please supply
supporting documentary information)
Signature
Signed on behalf of the applicant
Name
Position
Signature
Date
dd/mm/yy
PRA/ FCA  Application for approval of use of words credit union in name Release 1 April 2013
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Annex 1
Annex 1
Supplementary application for ‘Friends of xyz Credit Union’ groups to be completed by
the supporting credit union.
2.1 Name and address of Credit Union
Name
Address
Postcode
2.2 Firms reference number
2.3 Contact details
Name
Phone number
Declaration
This is to confirm that the credit union is content for
[applicant’s name]
to make an application to the FCA for the approval of the use of the above name
under section 3 of the Credit Unions Act 1979.
Signed on behalf of the credit union (the person signing this return should be an
‘Approved Person’ of the credit union).
Name
Position
Signature
Date
dd/mm/yy
PRA/FCA  Application for approval of use of words credit union in name  Release 1 April 2013
page 3