Full Name Identity Card No. Citizenship Date Of Birth Year1955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027 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 * 5 + 8 = Submit
