CSSL/BRO/F/017

CHAI SACCO SOCIETY LIMITED

MEMBERSHIP APPLICATION FORM

APPLICANT'S DETAILS
Surname: Other Names: Gender: M ❑ F ❑
Date of Birth: Marital Status: Occupation:
CONTACT DETAILS
Postal Address: Postal Code: Town/City:
Telephone: Cell Phone No: Email Address:
PHYSICAL ADDRESS
Location: Street/Building/Estate: House Number:
HOME/PERMANENT ADDRESS
P.O. Box: Street/Building/Estate: Town/City:
IDENTIFICATION
ID No.: (Attach copy) Place of Issue: KRA PIN:
Passport No: Issue Date: Expiry Date:
NEXT OF KIN DETAILS
Name: Relationship: ID No.:
Tel. No.: Postal Address:
EMPLOYMENT DETAILS (To be completed by employed applicant)
Name of Employer: Department: Payroll No.:
Tel. No.: Location: Emp. No.:
Station: Expiry of Contract:
Terms of Employment:(Permanent/Contract)
IF SELF EMPLOYED (To be completed by a business applicant)
Business Name: Street/Building/Estate:
Office Number: Nature of Business:
SOURCE OF FUNDS (Tick as appropriate)
Salary: ❑ Business: ❑ Pension: ❑
Others: (Specify)
ESTIMATED MONTHLY INCOME LEVELS (Tick as appropriate)
❑ 0 -20,000 ❑
20,001 -50,000 ❑ 50,001-100,000 ❑ Over 100,000
DETAILS FOR CHAI ANGELS JUNIOR ACCOUNT (Attach copy of child's birth certificate/notification)
Surname: Other Names: Gender:
Contribution per Month:
CHAI PREMIER HOLIDAY ACCOUNT
Monthly Contribution Kshs.
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DEPOSIT CONTRIBUTION
Monthly Deposit (Ksh) Amount in words
Proposed Mode of remittance: ❑ Check-off ❑Standing Order ❑Direct Debit ❑Other (specify)
Effective Date (dd/mm /yy)
SAVINGS CONTRIBUTION
Monthly Savings: Amount in words (Ksh)
SHARE CAPITAL
No of Shares applied for: Amount (Ksh)
Monthly contribution:
NOMINEE
Nominee’s Name……………………………………….....Id No: ……………………………………Relationship: ..………………….
Phone No:………………………………………………….. P.O.Box:…………………………………...........%......................................
Nominee’s Name…………………………………………Id No: ………………………………........Relationship: ………………….
Phone No: ……………………………………………....P.O.Box:…………………………………………......%..........................................
Nominee’s Name………………………………………....Id No: ………………………………........Relationship: ………………….
Phone No: ……………………………………………....P.O.Box:…………………………………………%......................................
Nominee’s Name…………………………………………Id No: …………………………………....Relationship:..…………………
Phone No: ……………………………………………....P.O.Box:……………………………………........%......................................
Nominee’s Name…………………………………………Id No: …………………………………....Relationship: ….........................
Phone No: ………………………………………………P.O.Box:………………………………….............%.......................................

APPLICANT'S SIGNATURE

RECRUITER
I…………………………………………………………… ID./NO................................................ M/NO …………………......…...

confirm that the applicant is capable of operating an account independently as a member of Chai Sacco Society Ltd.

Recruiter's signature …………………………..........… Date ……………………………….....…

OFFICIAL USE ONLY

Membership Category: ❑ Corporate ❑ Business ❑ Individual ❑ Other

Membership Fee paid (Ksh) Date Paid: Mpesa/Teller Transaction No:

Member Approved by: Signature:

Activated by: Signature:

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2. The Sacco Link Card is for use only at Co-op Bank ATMs, other Bank Visa
MEMBERSHIP TERMS & CONDITIONS
branded ATMS and at Visa branded merchant point of sales.
MEMBERSHIP ELIGIBILITY 3. The Sacco/Bank reserves the right to withdraw the use of Sacco l
Any natural, legal or a group of person(s) eligible for membership of the ink Card or to refuse request for authorisation of any Sacco
society may apply to be members by completing an "application for Link card transaction at anytime and without prior notice.
membership" form, and may be admitted if they meet the following 4. The Sacco Link Card once issued to the Cardholder is not transferable.
requirements: 5. The Sacco Link Card is the property of the Sacco and the Card holder
a)Is within the field of membership provided for in the bylaws. undertakes to return the card to the Sacco or Sacco/Fosa on demand.
b) Is not less than eighteen years of age. 6. The card must not be used for any unlawful purpose, including the
c) Is not directly, a money lender or carrying out such activities purchase of goods or services prohibited by local and international law.
detrimental to the objectives of the Society is of good character.
d) Has regular income from employment, business or trade. USE OF PERSONAL IDENTIFICATION NUMBER (PIN)
e) Has paid entrance fee and minimum shares as prescribed in the 1. The Cardholder will be issued with a PIN.
membership policy. 2. The Cardholder shall exercise due care and attention to ensure safety of
f) Has filled a nominee form (Next of Kin) the card and secrecy of the PIN at all times and to prevent the loss of and
or use of the card or PIN by any third party.
g) Has understood the objectives of the Society, his obligations as a
member and other membership requirements as stated in the By-laws. 3. The Sacco is authorized to debit the Cardholder's account with all
amounts withdrawn by means of the Sacco Link Card using the PIN.
MEMBERS' RIGHTS 4. The cardholder must not put the card and PIN together. The Cardholder
The following are the rights that you enjoy as a member of Chai Sacco: should change the PIN immediately on suspicion the PIN is
a) Receiving, periodically and regularly, or upon request, and at least once compromised.
a year, a statement of accounts containing the record of his credit and
debit transactions. LOST/STOLEN SACCO LINK CARD
b) Attending and participating in elections within the electoral zone. Each 1. If the Sacco Link Card is lost or stolen or misplaced the Cardholder must
member shall have one vote irrespective of his/her total shareholding. notify the Sacco or call the number on the reverse side of the Sacco Link
c) Electing representatives to attend and participate at a general meeting. Service Point. Verbal notification must be confirmed in writing
d) Electing or be elected as an officer of the Society, unless otherwise immediately; and a lost/stolen letter of indemnity shall be signed by the
prohibited by any other law or these By-laws. Using the Society's Card holder.
2. A Lost or stolen card notice shall indicate the particulars of the
services according to the policies and procedures approved by the
cardholder including name, address, Branch that issued the Card,
Board of Directors.
account number, card number, and date of reporting. Once the notice is
a) Submitting projects or initiative to the Board of Directors, for the
received the particulars of the Lost/stolen Sacco Link Card will then be
improvement of the Society's services.
input on the Hot Cards list.
b) Appointing a nominee.
3. In case of dispute over effective date and time of reporting loss or theft,
c) Participating in the sharing of the Society's surpluses.
in relation to 1 above, the time and date of receipt of the written
d) Accessing all legitimate information relating to the Society, including
confirmation shall be regarded as the date of notification to the Bank.
internal regulations, registers, minutes of the Annual Delegates
Meetings, Supervisory Committee reports, and annual accounts, at the 4. The Cardholder shall be liable in respect of any transaction instructions
registered office of the Society, subject to the Society's policies and affecting the Sacco account that is given with a valid PIN.
3. In case of dispute over effective date and time of reporting loss or theft,
regulations in force at the time.
in relation to 1 above, the time and date of receipt of the written
e) Voting on all matters put before the electoral zone.
confirmation shall be regarded as the date of notification to the Bank.
f) Enjoying all other rights as prescribed by the Co-operative Act and the
4. The Cardholder shall be liable in respect of any transaction instructions
Rules.
affecting the Sacco account that is given with a valid PIN.
MEMBERS' OBLIGATIONS 5. The Cardholder shall give to the Bank or any person acting on Bank's
behalf all necessary assistance in any investigations, avail all
a) As a member of Chai Sacco you are obliged to:
information as to the circumstances of the loss or theft of the Sacco Link
b) Be faithful and honest in all their dealings with the Society.
Card, and take all reasonable steps to assist recovery of the Sacco Link
c) Observe the law, the rules and these By-laws whenever transacting any
Card.
business with the Society.
6. A lost card that is recovered by the Cardholder should be returned to
d) Observe the code of conduct and ethics of the Society, and in particular
the nearest branch of the Sacco. The Sacco or Bank has discretion on
desist from any corrupt practices in all dealings with the Society.
approving continued use of such a card.
e) Refrain from engaging in the business of money lending in competition
7. If the report of a loss or theft of card is communicated by someone
with the Society.
other than the cardholder, the Sacco/Bank shall not be held liable for
f) Protect the image of the Society and avoid unnecessary publicity,
any damages thereto.
incitement or careless talk that can injure the reputation of the Society.
The cardholder should sign on the panel provided on the reverse of the
g) Inform the Chief Executive Officer in writing of change of my physical card on receiving the card. The signature should be similar to that on the
address and contact details whenever they occur.
National ID otherwise the card maybe rejected by merchants.
h) Pay my debt obligations to the Society without fail and save regularly
with the Society. 24 HR SERVICE HOT LINE
i) Seek cooperative education to improve my awareness and The card 24hr hotline number is found on the reverse side of the Sacco Link
enlightenment on cooperative matters. card. Cardholders should keep the 24 hour hotline number in their mobile
j) Attend meetings and education forums and take part in Society's number or frequently used telephone book.
decision-making. REPLACEMENT OF CARDS
k) Inform non-members and encourage them to join the Society. i) The Sacco shall replace lost or damaged cards within 2 weeks. The
Identify problems affecting the Society and suggest solutions. cardholder will be expected to pay for the replacement of the card at a rate
m) Participate in the Society's projects, both physically and financially. that may change from time to time.
n) Make use of the services of the Society as stated in its objects.
FORGOTTEN PIN
o) Comply with these By-laws, the Co-operative Act, the Sacco Act, Rules,
If a PIN is forgotten the Cardholder shall return their Sacco Link card to the
Regulations and resolutions of General Meetings.
Sacco where a replacement card will be ordered at a fee.
CONDITIONS FOR USE OF ATM CARD CANCELLATION, STOPPAGE OF SACCO LINK CARDS AND PAYMENT
GENERAL CONDITIONS 1. The Cardholder may at any time cancel his/her Sacco Link Card by
1. The Sacco Link Card is neither a credit card nor a cheque guarantee card returning it to the point of issue. If the return is made by mail the card
and shall not be presented as such. must be cut into two.

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2. Payments made by means of the Sacco Link debit card are irrevocable. 24 Hour Service Hotline
3. In case of a problem the Bank/Sacco may at any time cancel and/or The card 24hr hotline number is found on the SMS received when one is
stop a card without notice or assigning any reason and without registered for M-Chai Service.
incurring any liability to the Cardholder until a solution is found. Subscribers' should keep the 24hr Customer Care number in their mobile
4. On closing of the account on which the Sacco Link Card is operated, it or frequently used telephone book.
shall be the duty of the Cardholder to return the Card immediately to
FORGOTTEN PIN
the point of issue.
If a PIN is forgotten the subscriber is required to contact the Sacco to
CHARGES request for a new PIN.
The Sacco shall levy charges for the use of the service which may change
from time to time. The Cardholder shall be informed of such changes by CANCELLATION, STOPPAGE OF M-CHAI SERVICE
notice in Sacco's Branches. a) The subscriber may at any time cancel or unsubscribe for M-Chai
service.
LIABILITY OF A CARDHOLDER b) Payments made by means of M-Chai service are irrevocable.
Subject to above condition, Cardholders shall be fully liable in respect of c) In case of a problem the Sacco may at any time cancel/stop the service
each transaction instruction. without notice or assigning any reason and without incurring any
liability to the subscriber until a solution is found.
*FOSA Savings Account is mandatory to all members M- CHARGES
CHAI TERMS & CONDITIONS The Sacco shall levy charges for use of this service. The subscriber shall be
informed of such changes by notice.
DEFINITION OF TERMS
"Sacco" refers to Chai Sacco Society Ltd LIABILITY OF THE SUBSCRIBER
"M-Chai" refers to the Mobile banking solution service. Subject to above terms and conditions of use, subscribers' shall be fully
"Customer instruction" means any request or instruction from the M -Chai liable in respect of each transaction instruction.
customer to the Sacco.
"PIN" means any confidential password, code or number normally 4 digits ACTS THAT DO NOT BIND EITHER PARTY
which may be used to access the M-Chai services. Neither party shall be liable for failure or delay in the performance of its
"M-Chai Tariff —refers to the M-Chai transaction charges obligations under this agreement to the extent that such failure or delay is
"24Hr service hotline" refers to the telephone number that will be provided for caused by matters beyond that party's reasonable control including but not
M-Chai customers in case of any queries related to M-Chai services. limited to network delays, destruction arising out of war, rebellion, civilian
"Subscriber" means a member who subscribes to use M -Chai Service. commotion, strikes, lockouts and or other acts or orders of any government
department, council or other of constituted body. Notice of these
GENERAL CONDITIONS
circumstances shall be given to the other party as soon as practical. For so
Joint Account
long as performance of those obligation is suspended the other party may
Account held jointly by two or more persons whose mandate is Any sign"
similarly suspend performance of its obligation.
accounts which require more than one signatory will not be issued with M -
Chai Service. USE OF PERSONAL IDENTIFICATION NUMBER (PIN) AMENDMENT
a) M-Chai subscriber shall receive an SMS informing them of their These terms and conditions may be amended at anytime by notice from the
registration and PIN. Sacco to subscriber. The subscriber will be informed of such amendments
b) The subscriber shall be required to change the PIN before using the M - by notice at Sacco's branches. Any such amendments shall be deemed to be
Chai Services. effective and binding upon the subscriber upon publication of the notice.
c) The subscriber shall exercise due care to ensure the secrecy of the PIN at
all times and prevent use of PIN by any third party LAW
These terms and conditions shall be governed and construed under the
LOST/STOLEN SIM CARD REGISTERED FOR M-CHAI SERVICE laws of the Republic of Kenya.
a) If the subscribers' loses his/her SIM Card line registered with M -Chai,
the subscriber must notify the Sacco immediately to block M -Chai EMAIL/FAX INDEMNITY
Service until the SIM Card is replaced. I, the member, do authorize within the framework of functioning of Chai
b) The subscriber shall be liable in respect of any transactions instructions Sacco that Email/ Fax instructions (if opted for) will be acted Chai Sacco is
affecting his/her Sacco account that is given with a valid PIN. not liable in case of any incident that might arise upon execution of such
c) If report of loss or theft of SIM Card registered for M -Chai service is orders and that the member acknowledges and is fully aware and is
communicated by someone other than the subscriber, Sacco shall not be cognizant of the various risks inherent and associated with communication
held liable of any damages thereto. and instruction through email and facsimile transmission and is fully
prepared to accept such risks and that it is not in the interest of Chai Sacco
to assume such risks that have far reaching consequences.

I accept and agree to the terms and conditions that govern Chai Sacco Society Ltd. I warrant that the information given
here is true and complete. Without any objection I authorize the society to process the data and share it with any relevant
third parties as instituted in the sacco by-laws. I consent to withdrawing further processing of my personal data following
implications laid out in the society’s by-laws.

Consent for marketing purposes: We would like to use your details to provide you with information on Sacco products,
services and special offers from us.

Signature Date

Chai House, Ground & Mezzanine floor, Koinange street. P.O. Box 278- 00200 Nairobi
Tel: +254 709808000/0709808100 Email: [email protected] Website: www.chai-sacco.co.ke
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