MEMBER UPDATE FORM

PERSONAL DATA
Surname:
Male :

Middle Name:

WILLIAMS

ALASTAIR

Previous Name(s)

OTONY

First Name:
Alias(es)

Female:
Place of Birth:

Date of Birth (dd/mm/yy)

Marital Status:

17/07/1965

WESTMORELAND

Country of Birth:

JAMAICA

MARRIED

Current Home Address: LOT 355 LLANDILO HOUSING SCHEME, PHASE 4

Previous Home Address:

SAVANNA LA MAR, WESTMORELAND

34 CHANTILLY GARDENS, SAVANNA LA MAR, WESTMORELAND

Mailing Address (if different from above):

TRN: 100 100 465

C/O JPSCO LTD, BOGUE INDUSTRIAL ESTATE, MONTEGO BAY

ST JAMES

Telephone No.
918-2369
Home:
Cell: 878-4028
EMPLOYMENT INFORMATION

Current Employer:

E-mail Address:

pamotony@yahoo.com

JAMAICA PUBLIC SERVICE CO LTD

Employer Address:

How long?

Phone:

Fax:

BOGUE INDUSTRIAL ESTATE, MONTE BAY

ST JAMES
E-mail:
878-4028
oawilliams@jpsco.com

Profession/Occupation:

971-7268

Gross Monthly Salary:

Expected Monthly Deposit to Credit

Union:

Source of Other Income

Do you own a Business?

CLAIMS INVESTIGATOR
Other Income (monthly)

35 YEARS

NO
Name of Business:
Address of Business:
Type of Business:

Phone:
IDENTIFICATION

Type of Identification:
Drivers Licence:
Date Issued:

Passport

National ID
Date Expired:

Other

SIGNATURE
I authorize the verification of the information provided on this form. I also grant permission to JPS & Partners for this
information to be shared with third parties where applicable by law.
Signature of Member:

Member Update Form

12/2011

Date: