OTUOMA SACCO - Online Membership Application

                    
                        I hereby apply for membership of Otuoma Savings & Credit Society Cooperative Limited and agree to abide by the By-Laws, rules and any amendments thereof as may be decided from time to time.

Have you been a member before?

Yes No

Personal Information

Full Name *

Date of Birth *

Mobile Number *

ID / Passport Number *

Member Number

Gender

Marital Status

Email Address

Postal Address

Postal Code

Town

Residence

County

Sub County

Ward

Employment Details

Employer

Employer Address

Designation

Employment Terms

Permanent Casual Contract

Contract End Date

Staff / Check Number

Work Station

Former Employer

Pension Number

Business Details

Business Name

Nature of Business

Business Address

Monthly Contributions

Monthly Contribution (KES)

Amount In Words

Effective Date

Proposed Mode of Remittance

Salary Deduction Cash Bank Transfer M-Pesa

Next of Kin

Next of Kin Name

Relationship

Phone Number

Nominees (Warithi)

I, ID No. being of sound mind and under no duress, declare that in case of my death, the person(s) stated below shall be paid my deposits.

No	Name	Relationship	%	ID Number	Phone
1
2
3

Registration Fee (KES)

Applicant Online Signature

Applicant Name

Date

Witness 1 Name

Witness 1 Date

Witness 2 Name

Witness 2 Date

Indemnity Clause:

I/we agree that this account shall be operated solely at the discretion of the Sacco and hereby indemnify the Sacco against any loss incurred or claims arising out of the account.

Signed By

Date

Recruiter Details

Recruited By

Member / Staff Number

FOR OFFICIAL USE ONLY

Date of Admission: ________________________________

Allocated Membership No: _________________________

Registration Processed By: ________________________

Signature: _______________________________________

Approved By: _____________________________________

Signature & Official Stamp: _______________________

Membership Requirements

Copy of National ID
Copy of KRA PIN
Passport Photo
KES 1000 Registration Fee

Upload ID Copy *

Upload KRA PIN *

Upload Passport Photo *

MEMBERSHIP APPLICATION FORM