Membership | Concorde Sacco

I do hereby request to be admitted into the membership of Concorde Co-operative Savings and Credit Society Ltd and do agree to abide by all the By-laws and /or any amendments thereof:

Personal Information

Please fill in your personal details below.

Surname Name

First Name

Other Names

ID/Passport Number

Mobile Number

WhatsApp Number

Date of Birth

Present Address

Home/Permanent address

District

KRA PIN No

Alternative Phone Number

Marital Status

Gender

Religion

Location

Sources of Income

Enter information below

Select one source of Income *

Salary Income

Pension income

Other(Kindly Specify)

Enter your Preferred Monthly Contribution(Minimum Ksh.2,500)

Enter Amount in Words

Proposed Mode of remittance *

Check Off

Standing Order

Direct Debit

Other(Specify)

Effective date

Beneficiary Nominee Information

1st Beneficiary Details

First Name

Middle

Last Name

ID Number

Phone Number

Percentage Allocated

Relationship

Date of Birth

2nd Beneficiary Details

First Name

Middle

Last Name

ID Number

Phone Number

Percentage Allocated

Relationship

Date of Birth

3rd Beneficiary Details

First Name

Middle

Last Name

ID Number

Phone Number

Percentage Allocated

Relationship

Date of Birth

4th Beneficiary Details

First Name

Middle

Last Name

ID Number

Phone Number

Percentage Allocated

Relationship

Date of Birth

5th Beneficiary Details

First Name

Middle

Last Name

ID Number

Phone Number

Percentage Allocated

Relationship

Date of Birth

If any of the above mentioned person(s) has not attained the age of majority(18 years),the section below must be completed by naming a guardian(s) who must be over 18 years of age.

Guardian Information

1st Guardian Information

Full Names

ID Number

Relationship

Phone Number

2nd Guardian Information

Full Names

ID Number

Relationship

Phone Number

3rd Guardian Information

Full Names

ID Number

Relationship

Phone Number

4th Guardian Information

Full Names

ID Number

Relationship

Phone Number

Next of Kin Information

The Person to be Contacted Incase I am unavailable

First Contact Person

First Name

Middle

Last Name

ID Number

Relationship

Phone Number

Second Contact Person

First Name

Middle

Last Name

ID Number

Relationship

Phone Number

Third Contact Person

First Name

Middle

Last Name

ID Number

Relationship

Phone Number

Additional Details

Fill in your Referee Details and T-Shirt Preference

Referee Details

First Name

Last Name

Member Number

Phone Number

Relationship to the referee(wife/husband/son/daughter/friend)

What's your Preferred T-Shirt Size?

T-Shirt Size *

Small(S)

Medium(M)

Large(L)

Extra Large(XL)

Double Extra Large(XXL)

How did you hear about Concorde Sacco?

How did you hear about us *

Recommended by Friend or Colleague

Social Media e.g Facebook,Inst,Tiktok

Search Engine e.g Google,Yahoo,Bing

Other(Specify)

Congratulation {Name|name_4_40}

Your Membership Application Form has been Submitted Successfully!

We will contact you as soon as possible.

🌟Join our vibrant community 🌟

Membership Application Form

Personal Information

Membership Type

Section One: Employment Details(To be Completed by an employed Applicant)

Section Two:Business Details(To be Completed by an individual Applicant)

Sources of Income

Bank Details

Beneficiary Nominee Information

1st Beneficiary Details

2nd Beneficiary Details

3rd Beneficiary Details

4th Beneficiary Details

5th Beneficiary Details

If any of the above mentioned person(s) has not attained the age of majority(18 years),the section below must be completed by naming a guardian(s) who must be over 18 years of age.

Guardian Information

1st Guardian Information

2nd Guardian Information

3rd Guardian Information

4th Guardian Information

Next of Kin Information

First Contact Person

Second Contact Person

Third Contact Person

Additional Details

Referee Details

What's your Preferred T-Shirt Size?

How did you hear about Concorde Sacco?

Upload Section

Upload Passport Size Photo/Selfie

Upload National ID/Passport

Upload KRA PIN Certificate

Upload Signature Specimen

Registration Fee

Paste Transaction Confirmation Message below:

Congratulation {Name|name_4_40}

Your Membership Application Form has been Submitted Successfully!