Attach Passport

Photo

APPLICATION NUMBER
MEMBERSHIP APPLICATION FORM
MEMBER NO
Applicant Details
Full names

E-mail Address KRA PIN

ID/Passport No. Phone No.

Box No Code Town Residence Residence

Date of Birth (dd/mm/yyyy) Gender: Male Female

Marital Status: Single Married Others (specify)

Sources of income; Salary Business Pension Others (specify)

Current Employment Details

Employer Date of employment

Address

Position in employment Payroll/Staff number

Business Details
Business Name Business Address

Business Sector (Tick where applicable)

Transport Hospitality Real Estate Tourism Wholesale/retail Financial Services

Health Care Manufacturing Education Others (Specify)

Business Monthly Income (Ksh) Business Location

Remittance
Proposed monthly contribution (Ksh) Effective date

Amount in words

Mode of Remittance; Check off Direct Deposit Standing Order Paybill (M-pesa)

Other Services (Tick for registration)

Mobile Banking (M-Sacco Services) ATM Card at a fee of Ksh.600

Attach the following documents

 A copy of Identity Card or Passport
 Passport size photo
 Nominees for Deposits / Benefits in the event of Death
Name ID No Relationship % Date of Birth Mobile/Tel. No

Nominees for Group Funeral Expense (GFE) Scheme; limited to Spouse, Children & Parents of the member
Name ID No Relationship Date of Birth Mobile/Tel. No

Declaration
I hereby declare that all the information provided above is true to the best of my knowledge and undertake to abide by
the By-Laws of Maisha Bora Sacco Society Ltd.

Applicant Signature: Date

Introduced By/Referee: (Who should be a current member of Maisha Bora Sacco)

Name Member No

Mobile/Email

Signature Date

By-Laws
Please obtain a copy of our by-laws from our office or download it from our Website: www.maishaborasacco.com
FOR OFFICIAL USE

Data captured by Signature Date

System approval by: Signature Date

Membership approved by: Signature Date

Admitted by: Signature Date Date

Signature Date Date

Deliver completed form at our office or send on email to: info@maishaborasacco.com