MALAWI POLICE SAVINGS AND CREDIT COOPERATIVE SOCIETY LIMITED

MEMBERSHIP APPLICATION FORM

IDENTITY DETAILS

National ID

Upload National ID

Passport Photo

Upload Passport Photo

PERSONAL INFORMATION

Employment Number

Service Number

First Name (Dzina loyamba) *

Middle Name (Maina Ena)

Surname (Dzina La bambo) *

Marital Status *

Sex *

Date of Birth (Tsiku Lobadwa)*

CONTACT INFORMATION

Postal Address (Keyala)

Village/Headman (Nyakwawa)

District (Boma)

Traditional Authority (T/A) (Mfumu yaikulu)

Phone Number(s) (Nambala ya foni)

Email Address

BANK DETAILS

Bank Name *

Bank Branch *

Account Name *

Account Number *

DEDUCTIONS

Shares (MK)

Ordinary Savings (MK)

Special Saver (MK)

NOMINEES (Osankhidwa)

Name (Dzina) *

Birth Date (Tsiku Lobadwa)*

Relationship(Ubale) *

Percentage(Peresenti) *

MTHANDIZI FUNERAL COVER

Fill Mthandizi Funeral Cover Details

All members are entitled to funeral cover, which applies to the principal member, one spouse, and up to four (4) children under the age of 18. Please provide accurate details for your spouse and children (if applicable) to ensure they are included in the cover.

Contact Information

Contact Name *

Contact Phone *

Beneficiaries

Name (Dzina)*

Relationship (Ubale) *

Phone (Nambala ya foni)*

Declaration *

I hereby declare that the information provided for the Mthandizi Funeral Cover is true and correct. I understand the terms and conditions of the funeral cover program.

REFERRAL DETAILS

Referral Name

Referral Phone number

DECLARATION OF APPLICANT

Declaration: I hereby apply as a member of MALAWI POLICE SACCO. If admitted, I undertake to accept and abide by the code of conduct/Covenant/Rules & Bye-laws of the Cooperative and shall Endeavour to advance the course of the Organization. I certify that the information given on this form is true and correct and enclose payment for my membership application.

Applicant's Signature

Date

Any other Instructions: