Consent Form

Savings Consent

Full Name *

Amount in Words *

Membership Fee (UGX)

No. of Shares Purchased

NIN Number *

A/C Number

Email Address *

Contact *

Physical Address

Place of Work

Contact Information for Next of Kin

Name *

Relationship *

Contact *

Email Address

Signature (Member)

Sign here (print and sign)

NOTE: Attach photocopies of National ID, Driving Permit, or Passport.

Declaration

I declare that the information shared above is correct to the best of my knowledge and I shall abide by the byelaws of the SACCO as stated from time to time.

Member Name (Declaration)

Signature & Date

Sign & Date (print and sign)

For Official Use Only

Name (Treasurer)

Signature

Date

Name (Chairperson)

Signature

Date

For Official Use Only