BENEVOLENT FUND MEMBERSHIP
by Kisoo Ndambuki

          PERSONAL INFORMATION.

    I.D No.

    Company Name:

    Employee/Staff No.

    DETAILS OF DEPENDANTS:(lease list only your spouse, biological and legally adopted children and biological parents)

    No.

    N ames in full

    Date of Birth

    Sex

    Relationship

    Id No.

    1.

    2.

    3.

    4.

    MEMBERS BENEVOLENT FUND MEMBERSHIP FORM.

    I do hereby certify and confirm that the above information is true and correct and that in the event of any changes I will notify the society in writing within 14 days. Any information subsequently discovered as false will make me forfeit my claims.