Apstar Membership Form

Name

Phone

Email Address

Marital Status*

Married

Single

Source of Income*

Business Name*

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Nature of Business*

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Reg No

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Business KRA Pin

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Business Postal Address*

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Telephone No*

+254

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Approx. Monthly Income (Kshs)*

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Business Physical Location*

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Employer*

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Employers Address*

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Tel*

+254

Date of Appointment*

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Monthly Contributions (Subject to minimum) Kshs.*

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Benevolent Fund Mandatory of Ksh. 400

Mode of remittances*

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Check Off

Cash

Standing Order-FOSA

Standing Order-Bank

Effective Date*

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Please select a file to upload (National ID or Valid Passport)*

National ID

Valid Passport

Valid Passport Upload

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Max file size: 24.63 MB. | Allowed file types: gif,jpeg,png,jpg,pdf | Max number of file: 1 | Min number of file: 1

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ID photo - Front

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Max file size: 19.07 MB. | Allowed file types: gif,jpeg,png,jpg | Max number of files: 2 | Min number of file: 1

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Upload ID photo Back

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Max file size: 19.07 MB. | Allowed file types: gif,jpeg,png,jpg,pdf | Max number of files: 2 | Min number of file: 1

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Upload a Clear Passport Photo

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Max file size: 9.54 MB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

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Use my Safaricom Cell Phone Number:

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ATM Card :I do Authorize / Not Authorize Apstar Sacco to issue ATM card to my account.*

Yes

M-SACCO: I do Authorize / Not Authorize Apstar Sacco to register my FOSA account for M-SACCO banking services and issue me with M-Sacco credentials.*

Yes

Beneficiary (s)

	Name	ID No.	Address	Relationship	Distribution Ratio
	Name	ID No.	Address	Relationship	Distribution Ratio
1	Name	ID No.	Address	Relationship	Distribution Ratio
2	Name	ID No.	Address	Relationship	Distribution Ratio
3	Name	ID No.	Address	Relationship	Distribution Ratio
4	Name	ID No.	Address	Relationship	Distribution Ratio
5	Name	ID No.	Address	Relationship	Distribution Ratio

Spouse's Name*

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Spouse's National ID no.*

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Children Details

	Name	Gender	Age (Yrs)	ID No. (If over 18 Yrs)
	Name	Gender	Age (Yrs)	ID No. (If over 18 Yrs)
1	Name	Gender	Age (Yrs)	ID No. (If over 18 Yrs)
2	Name	Gender	Age (Yrs)	ID No. (If over 18 Yrs)
3	Name	Gender	Age (Yrs)	ID No. (If over 18 Yrs)
4	Name	Gender	Age (Yrs)	ID No. (If over 18 Yrs)
5	Name	Gender	Age (Yrs)	ID No. (If over 18 Yrs)
6	Name	Gender	Age (Yrs)	ID No. (If over 18 Yrs)
7	Name	Gender	Age (Yrs)	ID No. (If over 18 Yrs)

Referred by:

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I hereby declare that the foregoing particulars are true to the best of my knowledge and belief and agree to abide by the by-laws of the society and all relevant laws and regulations. I authorize the Society to make any necessary inquiries in connection with this application.

Upload a clear signature photo

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Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

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Signature Pad Title

Date Time Title*

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Form successfully restored

Benevolent Fund Mandatory of Ksh. 400

Valid Passport Upload

ID photo - Front

Upload ID photo Back

Upload a Clear Passport Photo

I hereby declare that the foregoing particulars are true to the best of my knowledge and belief and agree to abide by the by-laws of the society and all relevant laws and regulations. I authorize the Society to make any necessary inquiries in connection with this application.

Upload a clear signature photo

Signature Pad Title

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