CLOUDPESA SAVINGS AND CREDIT CO-OPERATIVE SOCIETY LTD

P.O BOX 956-00502, Nairobi

Tel: 0712228490 | Email: cloudpesasacco@gmail.com

INDIVIDUAL MEMBERSHIP APPLICATION FORM

Please complete in BLOCK LETTERS. Attach:

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

Click to upload Passport photo

SECTION A: APPLICANT'S DETAILS

Title

Mr.

Mrs.

Ms.

Other

Gender

Male

Female

Other

Surname

First Name

Other Names

Account Type

Date of Birth

Marital Status

Nationality

State / County / Province

Sub County

Location

Current Residence

Postal Address

Referee

Phone Number

Other Number

ID / Passport No

Email

KRA PIN

Employment Status

Department

Workstation

Payroll Number

Member Category

Occupation

Employer Name

Attach ID or Passport Document(s)

Click to upload

Attach Signature

Click to upload signature

SECTION B: Alternative Contact Person

Name

Relationship

Mobile

SECTION C: BANK DETAILS

Bank Name

Branch

Account Name

Account Number

SECTION D: CONTRIBUTIONS

Monthly Contribution

Monthly Contribution Amount (Ksh)

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 CLOUDPESA SACCO using any of the following options:

M-PESA
- Paybill: Your paybill
- Account: DEP<ID Number>
CO-OPERATIVE BANK
At the bank's branches and agents
- Account Number: your account number
- Member: DEP<ID Number>

SECTION E: MOBILE BANKING

Yes

No

Preferred Mobile Number

Mobile Banking PIN Request

SECTION F: TAX & COMPLIANCE

Tax Exempt

Certificate Number

Upload Tax Certificate

Upload Certificate

SECTION H: SHARIA COMPLIANCE

Uses Sharia Products Conventional Products

SECTION I: MEMBERSHIP REFERRAL

Introduced By

Recruiter

Marketer

SECTION J: Next of Kin

ID No	Name	Relationship	DOB	Contact	Address	% Share

SECTION K: Declaration

I declare that the information given above is true and correct to the best of my knowledge. I, the undersigned, make an application to join CLOUDPESA SAVINGS AND CREDIT SOCIETY LTD. I Undertake to comply,observe and abide by the by-laws and polices which are subject to review from time to time.

Date

Signature