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New Membership Application Form
Prerequisites
A valid and active email address where your OTP will be sent
A passport size photo of formats (.jpg, .jpeg, .png). Preferably 512 X 512 or a square ratio
Mandatory fields have (*)
Application Form
1. Personal Particulars
Surname *
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First Name *
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Middle Name
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Date of Birth *
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Gender *
Male
Female
Others
Marital Status *
Married
Single
Others
Contact Number *
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Email *
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Occupation (Max 50 words) *
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Employer *
AYO
EXQUISITE
FINCO
FLT
ISON
JOB CONNECT
MTN
MUBS
OTHERS
SACCO
Residential Address *
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Applicable Tax Identification Number
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Attach passport size photo * (Max size = 5MB |jpg, jpeg, png)
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Please add a picture here
National ID Number (NIN)
Postal Address
2. Next of Kin Declaration (1)
In the event of death, I hereby nominate the following persons to be considered for the receipt of all benefits less liabilities payable to me, under the 212 Staff SACCO.
NB;
Persons under the age of 18 years should not be nominated; instead a trustee should be considered.
Surname *
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First Name *
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Middle Name
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Date of Birth *
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Gender *
Male
Female
Others
Email
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Contact Number *
Invalid phone number.
Relationship *
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Occupation (Max 50 words)
Employer (Max 50 words)
Residential Address *
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Postal Address
3. Next of Kin Declaration (2)
In the event that the above named beneficiary is totally not available/ is totally absent , I nominate:
Surname *
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First Name *
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Middle Name
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Date of Birth *
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Gender *
Male
Female
Others
Email
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Contact Number *
Invalid phone number.
Relationship *
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Occupation (Max 50 words)
Employer (Max 50 words)
Residential Address *
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Postal Address
Subscription
Subscription deduction *
I hereby give the Company permission to deduct from my salary, an amount equivalent to
Ugx 50,000
and
Ugx 30,000
being payment for my membership and annual subscription respectively, under the 212 Staff SACCO.
You must agree to the subscription before submitting.
Deductions
I hereby give 212 Staff SACCO permission to deduct from my salary, a monthly amount
as specified below
being payment for my saving under the 212 Staff SACCO.
These deductions should take effect from
date specified below
until such a time when I inform the company otherwise
Amount *
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Date starting on *
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Send Application