MEN OF FAITH SELF HELP GROUP
MEMBERSHIP REGISTRATION FORM
PERSONAL INFORMATION
Full Name ……………………………......................... Member No………………………..
ID No……………………………… Mobile No………………………………………..........
Marital Status Married....... Single.......... Widow.......... Others...............
Residence Location.............................................................................................................
Source of Income Business.............................. Employed.....................................
NEXT OF KIN
Full Name…………………………………………………… Relationship………………….
ID No……………………………………… Mobile No………………………………….
DECLARATION
I nominate the person named above as my preferred beneficiary to receive any lump sum benefits payable by the Self-Help in the event of my medically declared insane, permanent incapability or death. The above named person is also responsible for all unsettled debts I might be having with the group. The nomination cancels and replace any previous nomination signed by me I declare that the details given above are correct to the best of my knowledge and belief.
Member Signature……………………………………..
GROUP OFFICIALS
Appraised by:
Name ......................................................Signature............................................Date................
Verified by:
Name…………………………………Signature………………………Date………………
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