Baptist Sacco Membership Application

Personal Particulars

Full Name (As per National ID)

Please enter your full name.

Mobile No.

Please enter a valid phone number (10-12 digits).

ID/Passport No.

Please enter a valid ID number (7-8 digits).

Date of Birth (dd/mm/yyyy)

Please enter your date of birth in DD/MM/YYYY format.

Marital Status

Please select your marital status.

Gender

Male

Female

Please select your gender.

Product Category

Please select a product category.

Physical Address

Please enter your physical address.

County

Please enter your county.

Postal Address

Please enter your postal address.

E-mail Address

Please enter a valid email address.

Church Region

Please enter your church region.

Association

Please enter your association.

Next of Kin Details

Full Name (As per National ID/Passport)

Please enter next of kin's full name.

Mobile No.

Please enter next of kin's phone number.

ID/Passport No.

Please enter next of kin's ID number.

Employment Details

Employer Name

Postal Address

Employer Contact Number

Employee Email

Profession

Payroll No.

Position in Employment

Work Station

Date of Appointment

Gross Monthly Income (Ksh)

Term of Employment

Permanent

Contract

Casual

Business Details (For Business Applicants)

Business Name

Business Address

Business Contact Number

Business Registration Number

Business Email Address

Nature of Business

Approximate Monthly Income (Ksh)

Business Location

Remittance Authorization

Monthly Deposit Amount (Ksh)

Please enter monthly deposit amount.

Share Capital Amount (Ksh)

Please enter share capital amount.

Membership Fee (Ksh)

Please enter membership fee.

Effective From (Month/Year)

Please select effective date.

Proposed Mode of Remittance

Please select remittance mode.

I hereby authorize you to deduct Ksh _____ monthly deposits contribution and Ksh _____ share capital contribution from my salary and/or any other mode of remittance and pay Baptist Convention Sacco Ltd with effect from the month of __________ until further notice. Membership of Kshs _____ will be deducted with the 1st deduction from payroll or any other mode of remittance arrangement with the society. *

You must authorize remittance deductions.

Beneficiaries

I the undersigned upon my demise whilst a member of the society, to the person(s) named in this section.

Beneficiary 1

Full Name

ID/Passport No.

Relationship

Contact Number

DOB

% Share

If nominee is under 18 years, provide guardian name

Guardian ID

Guardian Mobile

Introducer Details

Member Number

ID No.

Relationship

Confirm that the applicant is well known to me for:

Weeks

Months

Years

Attachments

Copy of National ID/Passport Accepted formats: JPG, PNG, PDF (Max 2MB)

Please upload a copy of your ID.

Passport Photo Accepted formats: JPG, PNG (Max 2MB)

Please upload a passport photo.

Member Signature Accepted formats: JPG, PNG, PDF (Max 2MB)

Please upload your signature.

I confirm that the information provided herein and disclosures made are true to my knowledge. I have read, understood and shall be bound by the Sacco rules, terms, constitutions and its by-laws. *

You must agree to the terms and conditions.

BAPTIST CONVENTION SACCO LTD

MEMBER APPLICATION FORM

Personal Particulars

Next of Kin Details

Employment Details

Business Details (For Business Applicants)

Remittance Authorization

Beneficiaries

Beneficiary 1

Introducer Details

Attachments