EABL Employee Experience Hub

Membership Application Form

Member Name

Fund/Scheme Name

Section A - Member’s particulars

(please complete in full)

KRA PIN

National ID No.

Date of Birth

Member’s Permanent

Residential Address

Permanent Address

P.O. Box

Town

Postal Code

County

Mobile No.

E-mail Address

Employee/Staff No.

E-mail Address Work

Date of Employment

Basic Salary (p.a.) KShs.

Gender

Male
Female

Martial Status

Bank Name and Branch

Account No.

Section B - Declaration by the employee

I hereby declare that the above statements are true and correct to the best of my knowledge and belief.

Employee Signature:

Date

Section C - Declaration by the employer

Does the information provided by the Employee in the section above agree in all respects with your staff records?

Declaration

Yes
No

Date the member joined the Scheme

I hereby declare that the above statements are true and correct to the best of my knowledge and belief.

Authorised signature:

Employer’s stamp

Name (Print)

Designation

Contact number

DateOfApplication

Copyright:

Copyright in this material is expressly reserved and this form and all attachments (where applicable) remains the exclusive property of Zamara Actuaries, Administrators & Consultants Limited. This form and all attachments (where applicable) may not be copied, stored, retrieved or in any way reproduced without the express written permission of Zamara Actuaries, Administrators & Consultants Limited. Breach of copyright is a serious offence and can lead to litigation.