DEPOSITS WITHDRAWAL FORM

KANISA REGULATED NON-WDT

SACCO SOCIETY LTD.

All Africa Conference Churches compound, Opp. Safaricom House, Waiyaki Way.

P.O. Box 1225 - 00606 Sarit Center, Westlands, Nairobi, Kenya - Tel: 4450135 / 0714-612049

Email: kanisa@aacc- or info@kanisa- - Website: kanisa-

DEPOSITS WITHDRAWAL FORM

TO:

The Chief Executive Officer,

Kanisa Regulated Non-WDT SACCO Society,

P. O. Box 1225-00606,

Nairobi, Kenya.

I ____________________________________________ Membership Number ______________________

ID No. ______________________ Tel/Mobile __________________________ hereby make an application

to withdraw my Deposits from Kanisa SACCO due to the following reason(s): (Tick as appropriate)

Loss of income/employment

Reduction of income

Health emergency/ Medical bills

Change of employer

Relocating outside the country

Other (Specify):

Transferring to another SACCO

Capital to start or boost a business

Meet basic needs (Domestic consumption)

Unsatisfied with products & services

School fees for self or children

I have guaranteed the following loans:

No

1.

2.

3.

4.

5.

Name

______________________________________

______________________________________

______________________________________

______________________________________

______________________________________

Amount Guaranteed

__________________

__________________

__________________

__________________

__________________

Balance

__________________

__________________

__________________

__________________

__________________

Kindly process my refund and any other future earnings, payable to:

Name

Address

Bank & Branch

Account Number

Mobile/MPesa Number

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

Signature: ____________________________

Date: ________________________________

FOR SOCIETY USE ONLY

STATEMENT OF MEMBER¡¯S TRANSACTION WITH THIS SOCIETY FROM

.¡­¡­¡­¡­¡­¡­¡­¡­¡­.... TO ¡­¡­¡­..¡­¡­¡­¡­¡­¡­..

GUARANTEED ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­

TOTAL DEPOSITS

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

ADDITIONS [ DR]:

Dividend payable

Insurance claims

Funeral Expenses Receivable

Loans refunds

Interest

Others

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

TOTAL DEPOSITS + ADDITIONS

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

DEDUCTIONS [CR]:

Loans

Interest

Insurance Premiums

Guarantor ship Liability

Bank Charges

Others

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

TOTAL DEDUCTIONS + PAYMENTS

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

NET PAYMENT DUE TO THE MEMBER

KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............

Cheque Number:

¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............................. Amount: KES ¡­¡­¡­¡­¡­¡­¡­¡­¡­..

Prepared by:

¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............................. Date:

¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­...

Checked by:

¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............................. Date:

¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­...

Collected by:

¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.............................. Date:

¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­...

 ................
................

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