Important: An entrance fee of Kshs. 1,000 should be included in the first month's contributions. Share capital of Kshs. 35,000 should be raised within the first 12 months of membership. The minimum monthly contribution is Kshs. 2,000.
Please attach one copy of your ID/Passport and KRA PIN, plus one recent passport-size photograph.
Full name (block letters) *
Date of birth *
ID/Passport number *
Postal address *
Physical address *
Mobile phone number *
Email address *
Source of funds *
SalaryBusinessProceeds from PensionOther
If other, specify
Copy of ID Front*
Copy of ID Back
Your Passport Photo*
Your KRA PIN*
Employer
Employer's physical address
Office telephone number
Position in employment
Work station
Department
Payroll number
Monthly contribution payment method (employed)
Check offStanding OrderCheque/Cash
Type of business
Consumption & Social ServicesLand & HousingAgricultureEducationManufacturingHuman healthInvestmentFinance & InsuranceTrade
Business/company name (if registered)
Postal address
Business telephone number
Business physical address
Business email address
Monthly contribution amount in figures (Kshs.)
Monthly contribution amount in words Monthly contribution payment method (business/self-employed)
Standing OrderCheque/CashM-Pesa
Introducer's name
Introducer's ID/Passport number
Introducer's member number
Relationship to applicant
Supporting document
Date
Full name *
Mobile number *
Relationship *
Nominate up to five people to receive the funds in your Shares and Deposit Account at your death, less any indebtedness owed to the Society. Total allocation should equal 100%.
Full Name
Relationship
Allocation (%)
ID (if applicable)
Contact/Tel No.
Enable mobile banking * YesNo
Receive promotional SMS/email * YesNo
I agree that Shelloyees Sacco may send text and multimedia messages to my wireless phone number about its products and services. I understand that I may withdraw this consent on request.
I hereby apply for membership of Shelloyees Savings and Credit Co-operative Society and confirm that the information I have provided is accurate.
Date of application *
Applicant's signature (upload an image of your signature) *
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