Membership Registration

Membership Application Form

Complete all five sections below. Fields marked * are required, and supporting documents can be uploaded as PDF, JPG or PNG.

1 Applicant

2 Income

3 Next of Kin

4 Documents

5 Declaration

1 Applicant Information

Membership Type * Title Full Name * National ID / Passport No. * KRA PIN Gender * Marital Status * Date of Birth * Phone * Email Current Address * Area of Residence * Town * County * Nationality * Estate / Village Religion *

2 Source of Income

Current Employer / Business Period in Current Employment / Business Employer / Business Address Average Monthly Income Employer / Business Phone Employer / Business Email City / Town County

3 Next of Kin / Nominees

Provide at least one nominee. Allocation percentages must total 100%.

4 Supporting Documents

Upload clear scanned copies. PDF, JPG or PNG.

National ID / Passport * KRA PIN Certificate * Passport-size Photograph * Next of Kin ID / Passport

5 Declaration

I declare that the information provided is true and agree to abide by the terms and conditions of the self-help group. Applicant Signature Name * Witness Name Witness Membership No. Witness Signature Name