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P.O.

BOX 66827 – 00800, WESTLANDS


TEL: (020) 4273228, 4273050, 4273438
JCC – Telephone (020) 427 2685

SACCO MEMBERSHIP WITHDRAWAL REQUEST

The Chief Executive Officer


Safaricom Sacco Ltd,
NAIROBI.

I do hereby request to withdraw my membership from Safaricom Sacco Limited w.e.f _____________________________ this being my
written notice. The reason for my withdrawal is ____________________________________________________________________________________

I am FULLY aware that according to the by-laws of Safaricom Sacco states that: A member may at any time withdraw from the society
by giving a written notice of ninety (90) days. No member will be allowed to withdraw from the Society before clearing all loan balances
if any; and thereafter the notice period, a member shall be refunded his monies within 30 days

I undertake to follow-up on the members whose loans I have guaranteed to ensure that I have been fully replaced. Otherwise, the
society will continue to hold on to my deposits until the loans guaranteed have been fully replaced.

Personal Account Details


FULL NAMES: …………………..…………………..…..………………………STAFF NO…………..……………. ID NO ………………………..
DEPARTMENT………………..……………...…DUTY STATION……………………..………..………………..……………
OFFICE NUMBER………………………………MOBILE PHONE NO…..……………………..…….……………………….
E-mail Address: (Official)….………………………………………………….……………..………………………………….
E-mail Address: (Personal)…..………………………...............................................................................

Bank A/C Name ………………………………………………………………………………………………………………………..………


A/C NO…………………………………………………………………….Bank …………..………..…Branch…………..…………………

I hereby make an application to withdraw from the Sacco and agree to conform to Safaricom Sacco by-laws and any amendment
thereof.

Signature of Applicant (Within the box)

FOR OFFICIAL USE ONLY


____________________________________________________________________________________________________________________________________

CHECKED BY AUTHORISED BY COMMITTEE


Staff Name…………………………………………….. Name…………………………………………….
Designation …………………………………………… Designation ………………………………………
Signature ………………………………………………. Signature ………………………………….………
Date …………..……………………………………….. Date ……………………………………………….

_____________________________________ _____________________________________

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