Membership Form

Full Name

Gender
MaleFemale

Date of Birth

National ID Number

Occupation

Employer / Business Name

Mobile Number

Alternative Phone Number

Email Address

Physical Address

Region

District

Membership Type
Individual MemberGroup MemberBusiness Member

Expected Monthly Savings (TZS)

Next of Kin Full Name

Relationship

Next of Kin Phone Number

National ID / Passport

Passport Size Photo

[acceptance* declaration]
I declare that the information provided is true and agree to abide by KIA SACCOS regulations.
[/acceptance]

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