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MEMBERSHIP APPLICATION

I, the undersigned, do hereby process an application in terms of the Article 7 of the Constitution for Membership of CoopCongo Cooperative and I submit the following personal information:

Personal and family information

Gender

MaleFemale

Marital Status

SingleMarriedDivorcedWidowedOther

If married, specify partner/spouse:

[tel telephone(w) "Telephone (Work)"]

[tel telephone(h) "Telephone (Home)"]

Next of Kin (a member of your immediate family)

Email Address

Contact Number

Person who instroduced you to CoopCongo

Email Address

Contact Number

Membership Contribution

An Amount of R100 (Once Off) is payable with the membership application form (Non-Refundable)

Annual Fee R 1200 (Non-Refundable)

R100.00

Contribution Date (01st / 05th / 25th / 30th)

Subscription shares

Beneficiary Full Name (1)

Gender

Relationship

Date of Birth

Beneficiary Full Name (2)

Gender

Relationship

Date of Birth

Beneficiary Full Name (3)

Gender

Relationship

Date of Birth

Beneficiary Full Name (4)

Gender

Relationship

Date of Birth

Beneficiary Full Name (5)

Gender

Relationship

Date of Birth

Beneficiary Full Name (6)

Gender

Relationship

Date of Birth

I hereby undertake as a member of CoopCongo Cooperative to abide by its Constitution and its Code of Conduct; I acknowledge these documents are available for download from the association’s website or can be supplied to me on request.

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Personal and family information

Membership Contribution

Useful Links

Activities Hours