REGISTRATION FORM

State the area you are appyling for

First Name

Last Name

Marital Status

Married

Single

DATE OF BIRTH

ID NO.

RESIDENTIAL ADDRESS

Address Line 1

Address Line 2

City

Country

OCCUPATION

WORK ADDRESS

CELL NUMBER

WORK CONTACT

Spouse Name

Spouse Last Name

Date / Time

ID No

Cell No.

Next of Kin

ID No.

Cell No.

Beneficiaries

Date Joined

Refferred by

Admin Fee Paid

TERMS AND CONDITIONS

A member shall pay a non-refundable USD200 (two hundred dollars) for registration and administration cost per stand.
All late payments (made after the 5th of the following month) attracts an interest of 5%
Any other costs outside the purchase price shall not be refunded if a client cancel or request for refund.
Failure to pay installments for 3 consecutive months results in default and repossession of the stand.
I hereby agree to be bound by the terms of the association whereupon or in the event that I require my refund for payments made towards the purchase of the stand, I shall furnish the association with a 90 working day’s notice and the association shall deduct 30% as inconvenience fees and shall refund the balance as a whole if funds permit or in equal installments as I have paid to them.

DECLARATION

I hereby certify that the information I have given is correct, should my application be accepted. I accept to be governed by the conditions and benefits as amended time to time by the Association.

SIGNATURE (Initiats)

DATE

REFERRED BY

First Name

Last Name