Full Name Identity Card No. Citizenship Date Of Birth Year1956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day MARTIAL STATUSSingleMarriedWidowedDivorced Marital Status Race Occupation GENDERFemaleMale Gender Home Address Post Code Tel. No. H/P No. Email Name Of Spouse Spouse Identity Card No. NO. OF CHILDREN12345678910 No. Of Children I hereby declare that if admitted as a member of the Co-operative Society, I will abide that By-Laws and rules of the Co-operatives Society and any amendments made to those By-Laws and rules. I hereby certify that I am not a bankrupt or a person against whom a conviction stands for a registrable offence and that I have not been expelled from membership od any Co-operative Society during the previous one year period. I agree to a minimum of 10% to be set aside for charitable and welfare projects from the profit made from all CSCs projects. Declaration1 * Leave this field blank Math question * 18 + 2 = Submit
