Passport photo

Membership Applica on Form

Applicants Details
Full Name.
Mobile No.

Tel No.

*Date of birth (dd/mm/yy)

Present address

Marital Status

Sex

*ID/passport No.

E-mail address

*Home /permanent address

District

Loca on

Sec on one : Employment Details (To be completed by an employed applicant )

Employer

Employers address
Work sta on
Gross Monthly Income

Date of appointment

Kshs.

Payroll Number

Sources of Income
Salary

Pension

Others (specify)

Sec on two: Business Details (to be completed by a business applicant)

Business Name

Business Address

Nature of Business

Approximate Monthly Income

Other Sources of Income

Pension income

Others (specify)
Amount in words

(dd/mm/yy)

Towards A Prosperous Future Together

Name

ID / No

Contacts Address/Tel

Applicant Signature

Date

Witness Name

Signature

Date of Birth

REFEREE
(To be lled by the member introducing the applicant)
I

P/No.

M/No.

Conrm that the applicant Mr/Mrs/Ms

is well known to me for

(wife/husband, son, daughter and Friend etc).

Referees signature

Date
MEMBERSHIP ELIGIBILTY

a) Is within the eld of membership provided for in the bylaws.

b) Is not less than eighteen years of age, if a natural person.
c) Is not a member of another salary based Sacco in the country.
e) Is of good character.
g) Has regular income from employment, business or trade.
h) Has paid entrance fee and minimum shares as prescribed in the membership policy.

in the Society By-law.

MEMBERS RIGHTS
a)

Receiving, periodically and regularly, or upon request, and at least once a year, a statement of accounts containing the

her total shareholding.

e)

Using the Societys services according to the policies and procedures approved by the Board of Directors.

MEMBERS OBLIGATIONS
a) Be faithful and honest in all their dealings with the Society.

of the Society.

Towards A Prosperous Future Together

Towards A Prospe

Towards A Prosperous Future Together

i)
j)
k)
l)
m)
n)

A end mee ngs and educa on forums and take part in Societys decision-making.
Inform non-members and encourage them to join the Society.
Iden fy problems aec ng the Society and suggest solu ons.
Par cipate in the Societys projects, both physically and nancially.
Make use of the services of the Society as stated in its objects.
Comply with these By-laws, the Co-opera ve Act, the Sacco Act, Rules, Regula ons and resolu ons of General Mee ngs.

CONDITIONS FOR USE OF MEMBERSHIP CARD

GENERAL CONDITIONS
1. The Membership Card is neither a credit card nor a cheque guarantee card and shall not be presented as such.
2. The Membership Card is for use only at Co - op Bank ATMs, other Bank Visa branded ATMS and at Visa branded merchant point of sales.
3. The Sacco reserves the right to withdraw the use of Membership Card or to refuse request for authorisa on of any Membership card
transac on at any me and without prior no ce.
4. The Membership Card once issued to the Cardholder is not transferable.
5. The Membership Card is the property of the Sacco and the Card holder undertakes to return the card to the Sacco or Sacco/Fosa on demand.
6. The card must not be used for any unlawful purpose, including the purchase of goods or services prohibited by local and interna onal law.
USE OF PERSONAL IDENTIFICATION NUMBER (PIN)
1.
2.
3.
4.

The Cardholder will be issued with a PIN.

The Cardholder shall exercise due care and a en on to ensure safety of the card and secrecy of the PIN at all mes and to prevent the loss
of and or use of the card or PIN by any third party.
The Sacco is authorized to debit the Cardholders account with all amounts withdrawn by means of the Membership Card using the PIN.
The cardholder must not put the card and PIN together. The Cardholder should change the PIN immediately on suspicion the PIN is
compromised.
LOST/STOLEN MEMBERSHIP CARD

1.
2.
3.
4.
5.
6.
7.

If the Membership Card is lost or stolen or misplaced the Cardholder must no fy the Sacco or call the number on the reverse side of the
Membership Service Point. Verbal no ca on must be conrmed in wri ng immediately; and a lost/stolen le er of indemnity shall be signed by the
Card holder.
A Lost or stolen card no ce shall indicate the par culars of the cardholder including name, address, Branch that issued the Card, account
number, card number, and date of repor ng. Once the no ce is received the par culars of the Lost/stolen Membership Card will then be
input on the Hot Cards list.
In case of dispute over eec ve date and me of repor ng loss or the , in rela on to 1 above, the me and date of receipt of the wri en
conrma on shall be regarded as the date of no ca on to the Bank.
The Cardholder shall be liable in respect of any transac on instruc ons aec ng the Sacco account that is given with a valid PIN.
The Cardholder shall give to the Bank or any person ac ng on Banks behalf all necessary assistance in any inves ga ons, avail all
informa on as to the circumstances of the loss or the of the Membership Card, and take all reasonable steps to assist recovery of the
Membership Card.
A lost card that is recovered by the Cardholder should be returned to the nearest branch of the Sacco. The Sacco or Bank has discre on on
approving con nued use of such a card.
If the report of a loss or the of card is communicated by someone other than the cardholder, the Sacco/Bank shall not be held liable for
any damages thereto.

SIGNATURE
The cardholder should sign on the panel provided on the reverse of the card on receiving the card. The signature should be similar to that on the
Na onal ID otherwise the card maybe rejected by merchants
24 HR SERVICE HOTLINE
The card 24 hr hotline number is found on the reverse side of the Membership card. Cardholders should keep the 24 hour hotline number in
their mobile number or frequently used telephone book.
REPLACEMENT OF CARDS
The Sacco shall replace lost or damaged cards within 2 weeks. The cardholder will be expected to pay for the replacement of the card at a rate
that may change from me to me.
FORGOTTEN PIN
If a PIN is forgo en the Cardholder shall return their Membership card to the Sacco where a replacement card will be ordered at a fee.
1.
2.
3.
4.

CANCELLATION, STOPPAGE OF MEMBERSHIP CARDS AND PAYMENT

The Cardholder may at any me cancel his/her Membership Card by returning it to the point of issue. If the return is made by mail the card
must be cut into two.
Payments made by means of the Membership debit card are irrevocable.
In case of a problem the Bank/Sacco may at any me cancel and/or stop a card without no ce or assigning any reason and without
incurring any liability to the Cardholder un l a solu on is found.
On closing of the account on which the Membership Card is operated, it shall be the duty of the Cardholder to return the Card immediately to
the point of issue.

perous Future Together

Towards A Prosperous Future Together

Towards A Prosperous Future Together

CHARGES

LIABILITY OF A CARDHOLDER

*All elds with are mandatory

* Fosa Prime Account is mandatory to all members
ATTACH THE FOLLOWING

2 coloured passport size photos

FOR OFFICIAL USE ONLY

Member interviewed by

Signature

Date

Imara
Omega
Novel
Biashara
Meridian
Investor
Any Other

Membership approved by

Signature

Date

Personal Number

Member Number

Data captured by

Signature

Date

System approval by

Signature

Date

Members le opened by

Signature

Date

P.O Box 75629 -00200, Tel: 3751292/4, 3752341/2/3, Mobile: 0724253918, 073360059, 0703024000 Fax 0208097265,

Towards A Prosperous Future Together