MNTC SACCO

Name*

Postal or Residential Address*

Primary Phone Number*

Alternative Phone Number

Age*

Date Of Birth*

NIN (National ID Number)*

Passport Number

TIN (Tax Identification Number)*

Marital Status*

Single Married Other

Name of Spouse

Spouse's Contact

Place Of Work (Current Employer)*

Designation (Job Position)*

Next Of Kin Name*

Next Of Kin's Contact*

Membership Fees(UGX 20,000 one off fee)*

Paid Not Paid

Number of shares purchased (minimum is 1 share and each share is UGX 20,000)*

Minimum Savings (UGX 20,000)*

Other Remarks (If any)

Nominated Beneficiary 1 (Name)*

Nominated Beneficiary 1 Relationship*

Nominated Beneficiary 1 (Contact)*

Nominated Beneficiary 2 Name (Optional)

Nominated Beneficiary 2 Relationship (Optional)

Nominated Beneficiary 2 Contact (Optional)

Nominated Beneficiary 3 Name (Optional)

Nominated Beneficiary 3 Relationship (Optional)

Nominated Beneficiary 3 Contact (Optional)

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