NOMINEE FORM

(Per By-Law 20)

To: The Chief Executive Officer,
Hazina Sacco Society Ltd,
P.O. Box 59877 – 00200,
NAIROBI.
Email: nominee@hazinasacco.or.ke

I………………………………………………………….. ID/No………………………of Post Office Box

………………………………… member of Hazina Sacco Society Ltd; being M/No…………………….
P/No………………….... (Employer)……………………………………………………. hereby nominate
the following nominee(s) to inherit my shares/deposits in the said Society in the following manner:
Name of Nominee(s) Relationship Contact Details % Shares/
(Phone, Email, Postal Address) Deposits
1

Given under my hand this……………day of………………..20…….. Signature…………………………

Witnessed by:

1. Name…………………………………………………..ID/No………………………M/No……….….

P/No………………….... Address……………………… Signature……………………Date….….......

2. Name…………………………………………………..ID/No………………………M/No……….….

P/No………………….... Address…………………………Signature……………………Date….…....

NOTE: Please ensure the form is duly filled. Send it in a sealed envelope marked nominee form,
bearing your full name and Personal/ID number or email: nominee@hazinasacco.or.ke