Membership Application Form

SECTION A: PERSONAL DETAILS

First Name

Middle Name

Last Name

Staff ID

EMAIL:

PHONE:

DEPARTMENT:

OFFICE LOCATION:

SALARY LEVEL AND STEP:

DATE OF FIRST APPOINTMENT:

 

SECTION B: NEXT OF KINDETAILS

First Name

Middle Name

Last Name

RESIDENTIAL ADDRESS:

EMAIL:

PHONE

 

SECTION C: CONTRIBUTIONS

TOTAL MONTHLY CONTRIBUTION:

INVESTMENT ACCOUNT (min. 50%):

SAVINGS ACCOUNT:

TARGET DATE:

TARGET ACCOUNT:

 

SECTION D: BANK DETAILS

BANKERS:

ACCOUNT NAME:

ACCOUNT NUMBER:

BRANCH SORT CODE:

 

SECTION E: AUTHORIZATION TO DEDUCT

I authorize the FCT-IRS Staff Multipurpose Cooperative Society (FISC) to deduct the said amount from my monthly salary, being my monthly contribution, with effect from

 

SECTION F: DECLARATION

I hereby apply for enrolment as member of the FCT-IRS Staff Multipurpose Cooperative Society (FISC) and promise to abide by its rules and regulations.

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