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NASFUND CONTRIBUTORS SAVINGS & LOAN SOCIETY

P O Box 7732, BOROKO, National Capital District, Ph: (675) 325 7166, Fax: (675) 325 6347

MEMBERSHIP APPLICATION FORM

Form SL5

Surname:

Given Name:

NASFUND Membership No:

EMPLOYER DETAILS:

Employer Name:

__________________________________________________________________________________________________

Employer Address:

__________________________________________________________________________________________________

Phone:

Fax:

 

Email:

 

 

 

POSTAL DETAILS:

 

 

 

 

 

 

Private Address:

 

 

Home Phone:

 

 

Home Village:

District:

 

Province:

 

 

PERSONAL DETAILS:

 

 

 

 

 

 

Date of Birth:

Sex:

Male

Female Marital Status:

Married

Single

other

__________________________________________________________________________________________________

Please tick the appropriate box:

I am not a member of another Savings & Loan Society

I am a member of another Savings & loan Society. Name of society:_________________________________________

I direct NCSL to close my existing accounting with immediate effect. (Refer Overleaf)

DECLARATION:

I hereby apply to become a member of the NASFUND Contributors Savings & Loan Society Limited.

I agree to pay all charges levied by the Rules of the Society and by any amendments thereof registered in accordance with the Savings & Loan Societies (Amendment Act 1995).

I agree to contribute no less than K20.00 per payment, to the NASFUND Contributors Savings & Loan Society.

NOMINATION OF BENEFICIARIES:

In the event of my death, the net proceeds of my account with the NASFUND Contributors Savings & Loan Society should be dispersed according to my most recent nomination as follows:

Names

Address

Relationship

Percentage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Applicant:

 

 

 

 

 

 

 

Witness Signature:

 

 

 

Name:

 

Date

/

/

__________________________________________________________________________________________________

OFFICE USE ONLY:

 

 

 

 

 

 

 

 

Date membership application and deduction forms received by Society:

/

/

 

 

_________________________________________________________________________________________

 

 

 

Approved

Rejected

 

Deferred

 

 

 

 

 

 

 

 

 

 

 

 

Date forwarded to PWM:

/

/

Membership number allocated:

 

 

 

 

NASFUND CONTRIBUTORS SAVINGS & LOAN SOCIETY

P O Box 7732, BOROKO, National Capital District, Ph: (675) 325 7166, Fax: (675) 325 6347

SALARY DEDUCTION AUTHORIZATION FORM

To:

The Pay Office

NASFUND Membership No:

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

Form SL1

I authorize the deduction of K________________________________ (note: minimum amount of K20.00) from my salary, to be paid weekly/fortnightly/monthly (circle whichever is applicable) to the NASFUND Contributors Savings & Loan Society on my behalf.

General Savings (S1)

Education Savings (S2)

Christmas Savings (S3)

Total

K

 

K

K

K

NOTE:

Members can allocate savings to one or more of the accounts listed above.

 

Name:

Signature:

Date: / /

EMPLOYER ACKNOWLEDGEMENT:

Signature of Authorised Official:

Designation:

Affix Company Seal Here

Date:

/

/

NOTE: After completing this Form, send it two (2) WEEKS Before the beginning of the deduction period to:

The Manager

NASFUND Contributors Savings & Loan Society Ltd

P O Box 7732

BOROKO

National Capital District