Kenya Police Investment Co-operative (KPIC)

MEMBERSHIP APPLICATION FORM

Kenya Police Sacco Plaza, Ngara Road, off Muranga Road, A / P.O.Box 51042-00200, Nairobi P/ 0709825000 E / kpics@policesacco.com W / www.policeinvestment.com

This section helps us collect Your personal information, but no data is shared to third party organizations.

APPLICANTS DETAILS

First Name

Middle Name

Last Name

Employer

ID/Passport No

Payroll No

Date of Birth

Gender

Female

Other

Male

Country

KRA Pin No.

Phone/Mobile

Email

Postal address

How would you like to receive your membership updates and other marketing information?

HOW DID YOU HEAR ABOUT US?

Referral Name

Kindly specify

NOMINATED NEXT OF KIN

I the undersigned, upon my incapacitation or demise whilst a member of the society, hereby instruct the society to pay all my dues less my debts to the Society, to the person(s) named herein as my nominated next of kin. I understand that the name(s) of nominee(s) can be given in sealed letter and that I may alter the name(s) of nominated next of kin by filling in a subsequent next of kin nomination form and that such subsequent instruction supersedes any that was given earlier.

Repeater Field

Full Names	Mobile No.	ID/Passport Number	Relationship	Date of Birth (D.O.B)	Percentage (%) Assigned

REMMITANCES

I hereby authorize you to deduct Kes

monthly through the mode of remittance selected below towards my account at Kenya Police Investment Co-operative Society with effect from

Mode of remittance

Employer (Checkoff)

Standing Order

M-PESA/Cash

Mpesa Transaction Code

Standing Order

Name of Witness:

I having read and understood the Terms & Conditions and the Privacy Policy hereby consent to receive updates and promotional messages from Kenya Police Investment Co-operative.

Reach out to us via email at kpics@policesacco.com

MEMBERSHIP APPLICATION FORM

APPLICANTS DETAILS

NOMINATED NEXT OF KIN

REMMITANCES

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