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MEMBERSHIP APPLICATION FORM
SECTION B: APPLICANT’S DETAILS
Surname:
*
Others
Gender:
*
Male
Female
Date of Birth:
*
Marital Status:
*
Occupation
*
County:
Sub county
Ward:
Location:
Sub location:
Village:
SECTION C: CONTACT DETAILS
Postal Address:
Postal Code
Town/City
Phone
*
Email Address
Telephone
SECTION D: IDENTIFICATION
ID NO.(Attach Copy):
KRA Pin:
Passport No
Expiry date
Upload file ID:
*
Choose File
No file chosen
Delete uploaded file
(Attach ID Copy)
Upload file KRA:
*
Choose File
No file chosen
Delete uploaded file
(Attach KRA PIN Copy)
Passport
*
Choose File
No file chosen
Delete uploaded file
(Attach Copy)
SECTION E: NEXT OF KEEN DETAILS
Name
Relationship:
ID No:
Cell Phone
*
Email Address
SECTION F: EMPLOYMENT DETAILS
Name of Employer
Payroll No:
County
Sub-County
Ward
Terms of employment
Employment Date
SELF EMPLOYED
Name Of Business:
Nature of Business
Location
Street/Building/Estate:
SOURCE OF FUNDS (Tick As appropriate)
Salary
Business
Pension
Others(Specify)
SECTION G: ESTIMATED MONTHLY INCOME
Tick as appropriate
0 - 20,000
20,001 - 50,000
100,001 – 200,000
Over 200,000
MONTHLY CONTRIBUTION
Amount in words
MODE OF CONTRIUTION
Check off
Salary Standing order
Pay bill (721876)
Cheque (In favour of Wevarsity Sacco Society Ltd KCB A/C: 1101921250), Kakamega Branch
Tick as appropriate
SECTION H: INTRODUCED BY
Name
ID No:
Designation
Member:
Staff:
Delegate:
Director:
Others
SIGNING MANDATE
I/we agree that the following signature(s) will make a valid transaction with Wevarsity Society Sacco Ltd (For Signatory Status it can be a Member or an Authorized Person)
Full Name(s)
I.D No
Signatory Status
Date
Signature
*
your signature here
Your browser does not support e-Signature field.
Full Name(s)
I.D No
Signatory Status
Date
Signature
*
your signature here
Your browser does not support e-Signature field.
ALTERNATE CHANNELS OF SUBSCRIPTION
Issue ATM Card
Mobile Banking Facility
SMS Alerts
Email
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