Membership Application

Join our cooperative today. Please have your ID and Payslip ready.

1. Personal 2. Employer 3. Banking 4. Savings 5. Declaration

Personal Details

Designation (Title)

Identity Number

First Name

Surname

Date of Birth

Email Address

Cell Phone Number

Home Telephone

Residential Address

Postal Address

Employer Details

Employer Name

Employer Address

Employee Number

Department

Work Telephone

Banking Details

Name of the Bank

Branch Code

Account Number

Type of Account

Monthly Savings Contribution

I will be contributing to Ziphakamise savings account on a monthly basis.

Amount (Min R200)

The monthly contribution will be made via:

First Contribution Date

Uploads & Member Declaration

Upload Certified ID (PDF/JPG)

Upload Latest Payslip (PDF/JPG)

Declaration

As a member of Ziphakamise Co-operative Bank, I undertake to support the principle of the Bank, the spirit of co-operation and democracy, abide by the credit rules as well as save and repay loan regularly.

I acknowledge that there is a non-refundable joining fee R200.00 and R200.00 shares that will be processed to my savings account.

Digital Signature (Type Full Name)

Date