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SACCOS Application Form
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1
Personal Details
2
Employer Details
3
Beneficiarie’s Details
Personal Details
Names
*
First
Last
Layout
Date of Birth
*
Gender
*
Gender
Male
Female
ID Number
*
Pay Roll No
*
Layout
Home Village
*
Ward/Kgotla
*
Layout
Home Address
*
Postal Address
Email Address
*
Layout
Contact Number (Home)
Contact Number (Cell)
*
Marital Status
*
Marital Status
Single
Married
Divorced
Widowed
Employment status:
*
Permanent & Pensionable
Contract
If contract state end period
*
Are you a member of any SACCOS
*
Yes
No
If yes state the name
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Employer Details
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Institution
*
Address
*
Contact Details (Work)
*
Layout
Fax
Name of supervisor
*
Designation
*
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Beneficiarie's Details
Names
*
First
Last
Layout
Address
*
Date of Birth
*
Layout
Home village
*
Kgotla/ward
*
Layout
Relationship
*
Sharing%
*
Names
First
Last
Layout
Address
Date of Birth
Layout
Home village
Kgotla/ward
Layout
Relationship
Sharing%
Declaration Section
Layout
Joining Fee (P)
*
Share Capital (P)
*
Monthly Savings (P)
*
Authorization
*
I authorize BOSETU SACCOS to deduct above amount from my salary.
DECLARATION
*
I hereby declare that the information stated above is true and complete to the best of my knowledge. I understand that if I have deliberately given false information or withheld any information regarding any situation, I am liable for prosecution for fraud and/or perjury.
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