CERTIFICADO ESCALABLE Formulario de Solicitud OAS Staff FCU 1889 F Street, NW y Washington, DC 20006 Tel: 202-458-3834 y Fax: 202-458-3838 INFORMACION DEL SOCIO Nombre No. de Cuenta Dirección No. de Apartamento Ciudad Estado/Zip No. telefónico País Correo Electrónico INFORMACION DEL CD Plazo (meses) 24 36 48 Monto del Certificado 60 US$ FIRMA DEL SOCIO Y ACUERDO I am aware that I can request an adjustment of the interest of the certificate, should the interest of Step-Up Certificates of similar terms have increased. I am aware that the increase in interest can be requested once for certificates of 24 and 36 months, and twice for those of 48 and 60 months and that I have the option to do so only after 12 months of the term have elapsed. My certificate will remain at the original term at the new rate. I am aware that the penalties for early withdrawal or cancellation will be charged as follows: 24 mo certificate, penalty is 270 days interest; 36 mo certificate, penalty is 450 days interest; 48 mo certificate, penalty is 600 days interest; and 60 mo. certificates, penalty is 950 days interest. In all cases principal may be affected. Firma Fecha PARA USO DE LA COOPERATIVA CD Amount: Interest Rate: Date of CD Renewal Date for optional adjustment Yield Imprimir