UNS/CE/VER:02/2023

MEMBERSHIP APPLICATION FORM

Requirements:
1. Passport size Photograph
2. National ID (Kenyans)/Valid Passport (Non-Kenyans)
3. A copy of Current Employment Contract/Pay slip
4. K.R.A Personal Identification Number (PIN) for Kenyans
5. For Kin applicants attach Marriage or Birth Certificate

A. Applicant’s Personal Details

STATUS: New Member Rejoining (Tick as appropriate)

TYPE OF MEMBER: Principal Member (Staff) Spouse Son/Daughter

FULL NAME: GENDER: Male Female Other

DOB: D D M M Y Y Y Y EMPLOYMENT NO.: AGENCY:

PAYROLL AGENCY: NATIONALITY:

CURRENT POSTAL ADDRESS: RESIDENCE:

PERMANENT POSTAL ADDRESS: COUNTY/DISTRICT/STATE:

MARITAL STATUS: Single Married Widowed Divorced Other

ID/PASSPORT NO: KRA PIN:

COUNTRY OF RESIDENCE: DUTY STATION:

CELLPHONE NO: PHONE 2:

PERSONAL EMAIL: EMAIL 2:

INTRODUCER’S NAME: MEMBER NUMBER:

B. Declaration
I hereby make an application for membership and agree to abide by the UN DT SACCO by laws and/or any
amendments thereof, the laws, policies, regulations and the terms and conditions for all my accounts. I further
understand that the operations of the FOSA Savings Account will be subject to the tariffs which are subject to
review by the management in line with business needs and agree to be bound by the same.

Applicant’s Signature: Date:

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 C. Nominee(s) / Next of Kin
I hereby nominate the persons listed below as nominees and/or beneficiaries to my account in case
of my demise. I understand that while acting in compliance to the law, the bylaws, and the policies,
the SACCO will abide by this list as my final will. The SACCO shall not be liable to any challenge,
litigation, disagreements or errors that may arise as a result of any interest in the estate/ savings.
The payments shall be made after settling all debts or obligations that may be associated with
my account.

Where minors are named as beneficiaries, a guardian must be provided. The SACCO is not obliged
to pay the guardian and may advice the appointment of the guardian as legal trustee of the minor.

ID/Passport Postal/ Email/ Guardian Details Name & ID

Full Name Relation Allocation
No. (Indicate Telephone/Address (for minors)
to Member in %
if Minor)

Applicant’s Signature: Date:

Witness

1. Name: Sign: Date:

2. Name: Sign: Date:

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 TO: UN DT SACCO

PAYROLL AGENCY:

AUTHORITY TO MAKE DEDUCTIONS FROM SALARY

I…………………………………………………Index No…………….hereby authorize you to deduct

Kenya shillings…………………………………….……………(Kshs…………………...) From my monthly

salary and pay to United Nations Deposit Taking Savings & Credit Co-operative Society Limited with

effect from the month of ……………20……. until further notice. Instructions to terminate this can

only be given with a written approval of the United Nations Deposit Taking Savings & Credit

Co-operative Society Limited. Please deduct an Entrance/Registration Fee of Kshs. 2,000/= or a

Rejoining Fee of Kshs. 3000/= along with the first contribution.

NON CHECK-OFF CONTRIBUTIONS

I…………………………………………………Index No……...……….hereby wish to contribute Kenya

shillings…………………………………….... ……..………(Kshs……………….…...) as monthly deposit

to United Nations Deposit Taking Savings & Credit Co-operative Society Limited with effect from

the month of ……………20……. until further notice. Instructions to terminate this can only be given

with a written approval of the United Nations Deposit Taking Savings & Credit Co-operative Society

Limited. Please deduct an Entrance/Registration Fee of Kshs. 2,000/= or a Rejoining Fee of Kshs.

3000/= along with the first contribution.

Applicant’s Signature: Date:

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 TERMS AND CONDITIONS OF MEMBERSHIP
1. By filling this form, I authorize the SACCO to to open my membership, share capital account and FOSA
savings account.
2. UN DT SACCO reserves the right to admit me into membership and/or discharge me from membership
if I do not abide by the by laws of the organization.
3. In the event of a breach/default, UN DT SACCO reserves the right of offset to any of my BOSA/FOSA
accounts without reference to me.
4. Minimum share capital as per Sacco by laws will have to be accumulated before crediting funds to the
other accounts (Deposit/FOSA). Only fully paid up share capital qualifies for dividend payment.
5. It is my obligation as a member to ensure I make regular monthly contribution to savings, prompt payment of
loans and raising the share capital. Where I do not meet minimum prescribed savings/deposits/loan
payments in a year, the dividend, rebates & interest payable will be used to update the same.
6. As a member, I shall be bound by all decisions of the general meetings. and I shall contribute to common
funds like insurance/benevolent contribution as prescribed from time to time.
7. By admission into membership, I commit to present complete and accurate information to the SACCO
through any documents submitted in hard or soft (digital) channels at all times.
8. The SACCO shall be deemed to have made formal communication to me through the latest registered email,
phone number, address, fax or other channels held in the SACCO’s records as shall be developed from time to time.
9. Broadcast communication to the membership through emails, SMS, website postings, newspaper, social
media or notice board by the SACCO shall be deemed to be sufficient communication to me as a member.
10. As a member, it is my right & obligation to access my statements regularly through the platforms provided
by the SACCO and seek for clarification/ corrections within 3 months on any item. Any matter not raised
within 3 months shall be deemed to be correctly posted.
11. My account shall be deemed dormant if i do not undertake any transaction over a period of 6 months.
Restrictions in operations shall be placed on such account. Activation of the account shall attract a fee as
prescribed in the tariff guide.
12. Accounts not operated for 5 years or more shall be deemed to be abandoned. The funds in these accounts
may be transferred to relevant government agencies.
13. The account shall attract interest & fees as shall be prescribed from time to time in the tariff guide available
to members,
14. Communication received from myself through my email, phone number or address as held in the SACCO’s
records shall be deemed to have originated from myself. I hereby undertake to indemnify the SACCO from
any liabilities arising from misuse, errors or compromise of such digital sources arising from these channels
as a member.
15. I shall enjoy all products and services offered by the SACCO without discrimination but within the product
features, terms, and conditions.
16. It is my obligation as a member to update the SACCO with any changes in my circumstances so that the
SACCO’s records are always up to date.
17. I understand that my personal data may be processed and used by the SACCO to improvise its products
and services. I therefore consent to the use and processing of my data in compliance with the law
I have read and understood the terms and conditions

Name: Signature: Date:

FOR OFFICIAL USE ONLY

Date of Admission………....….…….....….….......… Member No. Allocated………………....

Admitting Officer………………........…..…….......... Signature………………………………....

Approving Officer (Supervisor)……...........………... Signature…………………………...…….

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