Suluhu SACCO Membership Form

SULUHU SACCO SOCIETY LTD

SECTION A: Applicant’s Bio-Data

Title: Gender: Date:

Full Name (as per ID):

ID/Passport No: Date of Birth:

County: Sub County:

Postal Address: Code: Town:

Primary Mobile Number: Other Number:

KRA PIN: Email:

SECTION B: Occupation Details

EMPLOYED SELF EMPLOYED

Employer Name: Business Line/Type:

Employer Address/Contacts: Business Name:

Designation: Business Location:

Work Station: Business Address:

Payroll Number: Terms of Employment:

SECTION C: Other Sources of Income Pension Income: Others (Please Specify):

SECTION D: Remittances

Proposed Monthly Contributions (KES): Amount in Words:

Mode: Check Off Direct Debit MPESA Others:

SECTION E: Introduced By

Learned From:

Staff Name: Staff No:

Member Name: Member No:

Other Source:

SECTION F: Application to Open Savings Account

FOSA Account Name:

FOSA SAVINGS A/C SULUHU JUNIOR A/C GROUP A/C JOINT A/C DIVIDENDS A/C HOLIDAY SAVINGS A/C SAVERS A/C YOUNG PROFESSIONAL A/C SUPER FLEXI A/C

SECTION G: ATM Services

ATM Card: YES NO

SECTION H: Mobile Banking

Mobile Banking: YES NO

M-Banking Number:

SECTION I: Declaration

Name: ID:

Passport Photo: Signature:

Date:

SECTION J: For Official Use Only

KYC Name: KYC ID: KYC Signature:

Data Captured By: Signature: Date:

Approval By: Signature: Date:

Assigned Member No:

Introduced By: Signature: Date:

FOSA Opened By: Signature: Date:

FOSA Approved By: Signature: Date:

FOSA Account No:

File Opened By: Signature: Date: