MEMBERSHIP APPLICATION FORM

Please complete in BLOCK LETTERS. This form is complete when attached with:

One recent coloured passport photograph
Copy of National ID/Valid Kenyan Passport/Alien ID
Copy of KRA PIN

Click or Drag & Drop to Upload Your Passport Size Photo [required]

SECTION A: APPLICANT'S BIO-DATA

Fill in all fields marked [required] *

Account Type [required]

Date of Birth [required]

Marital Status [required]

Country of Residence [required]

Select a country

State / County / Province [required]

Select a country first

Attach ID or Passport Document(s)(PDF/Image)[required]

Attach KRA PIN Document (PDF/Image)

SECTION B: OCCUPATION DETAILS

Employed

Self Employed / Biashara

SECTION C: OTHER SOURCES OF INCOME

Pension Income

Others

SECTION D: REFERRER - How did you hear about us?

At least one option required *

Referrer Name:

Social Media:

Facebook

Twitter

Instagram

Other:

SECTION E: REMITTANCES

Please select at least one mode of remittance *

EMPLOYER (CHECK OFF)

STANDING ORDER or DDA

LIPA NA MPESA (SACCO PAYBILL)

FOSA STANDING ORDER

All payments shall be made to USERNAME SACCO, Account Number 01101498316001, held at Cooperative Bank of Kenya, Westlands Branch, or via MPESA Paybill 5551332 Account number put your National ID Number or Member Number.

SECTION F: NOMINEE/NEXT OF KIN DETAILS

Total % provided must sum up to 100% *

Please provide a guardian if the nominee(s) is/are below 18 years

Total % : 100.00%

Full Name	ID / Passport	Date of Birth	Relationship	Phone	% Assigned	Remove

SECTION G: DECLARATION

I declare that all the particulars given by me are true. I confirm that I have read the terms and conditions governing the opening, operating and closure of membership and related e-channels of Username Sacco and agree to be bound by them. I further unequivocally consent that my personal data, collected in connection with such terms and conditions, may from time to time be used and disclosed for such lawful purposes and to such persons as may be in accordance with the Username's Sacco's prevailing Privacy Policy, and the relevant laws, as amended from time to time.

Date [required]

Signature [required]

SECTION I: MEMBERS OBLIGATION

Members are required to make a minimum monthly deposit of Kshs. 1,000, consistently and without fail.
All financial obligations to the society, including loan repayments, must be honored promptly while still maintaining regular savings to enhance member support programs.
Uphold the highest standards of integrity by adhering strictly to the cooperative code of ethics and conduct in all engagements and transactions.
Commit to the continuous purchase and payment of shares while meeting all financial responsibilities as stipulated in the society’s bylaws.
Abide fully by the society’s By-Laws, the Co-operative Societies Rules, SACCO Act, Rules, Regulations, and any resolutions passed during General Meetings.
Conduct all dealings with the society with the utmost ethical integrity, refraining from any corrupt practices or activities.
Maintain a minimum share capital of Kshs. 5,000, payable within six months.
All members are required to pay a one-time, non-refundable registration fee of Kshs. 1,000 upon joining the society.