TYPE :
ACCOUNT :
Last Name:
Country of R
esidence:
Passport National ID
Place of Issue:
Female
Date of Birth:
Passport/ ID Number:
Date of Issue:
Cell Phone
E-mail:
Address (Town, City, Country, Code) Mobile
Telephone No:
Self Employed
Occupation/ Designation:
Employment Date:
E
MPLOYMENT/ BUSINESS DETAILS Salaried
Name of Employer
:
Employment T
erms:
Permanent
Contract
If Contract, Expiry Date:
Student ID No.:
Graduation Date:
Employer Address (Specify Town, City, Country)
STUDENT
School Name:
IMARISHA SACCO SOCIETY LTD.
MOI HIGHWAY, KERICHO/NAKURU ROAD, NEXT TO OILIBYA PETRIOL STATION
P.O Box 682-20200, Tel 254-052-21028/30229, KERICHO.
Cell 0720 290 22/Call Center 0709 578 000 Email: info@imarishasacco.co.ke Website: www.imarishasacco.co.ke
FOSA
Joint
Individual
BOSA
Relationship with Applicant:
Gender
Male
Female
NEXT OF KIN:
Relationship with Applicant:
Relationship with Applicant:
Male
APPLICANT DETAI LS:
First Name
Given Name
Identification Document:
ADDRESS:
Applicant Photo
Mapscent LLC
-------------
-
-----------------------------------------------------------------------------------------------------
MEMBERSHIP APPLICA
TION FORM
I
hereby
make
an
application
for
membership
in
the
society
and
agree to conform to the By-Laws and any
amendment thereof, and I will pay Kshs. 360.00 as a membership enrollment fee, and a monthly contribution of
Kshs. (minimum of Kshs. 1,600.00 per month, being sum of Depsoit/Shares contribution of
Kshs 1,200.00 and welfare contribution of Kshs. 400.00).
Student
Names:
Phone Number :
Address (Town, City, Country, Code) Mobile
Names:
Phone Number :
Address (Town, City, Country, Code) Mobile
Names:
Phone Number :
Address (Town, City, Country, Code) Mobile
Date of Birth:
Date of Birth:
Date of Birth:
Gender
Gender
Male
Male
Female
Female
