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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
An image of an identification document like a national ID or Passport 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 *
Invalid phone number.
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) *
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Postal Address
Attach ID/Passport * (Max size = 5MB |jpg, jpeg, png)
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Please attach a passport of National ID here
2. Next of Kin Declaration
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 MTN 212 Multipurpose Cooperative Society.
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. 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 share holding and annual subscription respectively, under the MTN 212 Multipurpose Cooperative Society.
You must agree to the subscription before submitting.
4. Deductions
I hereby give MTN 212 Multipurpose Cooperative Society permission to deduct from my salary, a monthly amount
as specified below
being payment for my saving under the MTN 212 Multipurpose Cooperative Society.
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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5. Bank Details
Account Name
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Account Number
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Bank Name
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6. Referee
If you were referred by someone to join the MTN 212 Multipurpose Cooperative Society, please provide their;
Full Name
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Membership Number
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Contact Number
Invalid phone number.
Send Application