Membership – MPSL

MEMBERSHIP APPLICATION FORM

YOUR NAME* YOUR EMAIL* EMPLOYER* EMPLOYMENT NUMBER*
ADDRESS AT WORK

RESIDENTIAL ADDRESS and TELEPHONE NUMBER

STREET* BUSINESS* MOBILE NO:* CURRENT OCCUPATION* HOME VILLAGE* HOME PROVINCE* DATE OF BIRTH* GENDER (Male /Female)* MARITAL STATUS* NUMBER OF CHILDREN YEARS OF SERVICE

NAME:* ID/CLIENT NO:* EMPLOYER* DEPARTMENT: *
CONTACT NUMBAR ( Business):* MOBILE*

Agree to ourLSD Account &LSD Policy ?

I authorise you to deduct from my fortnightly salaries and wages K, and remit to the Mining Petroleum Savings & Loan Society Limited effective PPE:.
This authority will remain in force and can only be rescinded upon notice to the Society.

CURRENT DEDUCTIONS		NEW DEDUCTIONS
S1 - Normal Savings		S1 - Normal Savings
S3 - Christmas Club		S3 - Christmas Club
S4 - School Fee		S4 - School Fee
S6 - Loan Security Deposit		S6 - Loan Security Deposit
L1 - Loan Repayment		L1 - Loan Repayment
L2 - Housing Loan		L2 - Housing Loan
Total Deductions	K	Total Deductions	K

BANK* BRANCH* ACCOUNT NUMBER*

NOMINATION OF BENEFICIARIES NEXT OF KIN	RELATIONSHIP	OCCUPATION	PERCENTAGE %

Have you joined M&P Savings & Loan Society before? YesNo

If yes, your previous employment number

I hereby apply to be admitted as a member of the above society and lodge herewith the sum of K2 to purchase one share (K1) in my name and (K1) to cover joining fee. I also enclose K to open my savings account.

If the above share is alloted to me, I agree to pay all charges and adhere to the rules of Society and any amendments thereoff registered in accordance with the Savings and Loan Societies Act 2015.

NOTE: ALWAYS LET US KNOW WHENEVER YOU CHANGE YOUR NAME AND ADDRESS