Withdrawal Form - Naciwasco Staff Welfare Association

NACIWASCO STAFF WELFARE ASSOCIATION
P . O . Box 1 8 5 8 2 – 0 0 1 0 0 , N a i r o b i ; E - m a i l : i n f o @ n a c i w a s c o . o r g
SERIAL NO.:
MEMBERSHIP WITHDRAWAL FORM
DATE:
The Secretary,
Naciwasco Staff Welfare Association,
P. O. Box 18582 -00100,
Nairobi.
Dear Sir,
RE: APPLICATION FOR WITHDRAWAL AS A MEMBER OF NACIWASCO STAFF WELFARE ASSOCIATION
I, ……………………………………………………………………...…………………….hereby request for your approval to
withdraw my membership from the Association with effect from (Date)……………………………..……………………..
My cumulative monthly subscriptions as at (Month, Year) ……………….………....……. is KES.……………..……………
while my outstanding loan is KES………………………………………………………………….………………………………
Kindly refund the balance of my cumulative monthly subscriptions less the requisite administrative fees if any.
My details are as follows:FULL NAME: ____________________________________________________________ PF/No.: _____________
ID/NO.: ___________________________________________ MOBILE NO.: ________________________________
DUTY STATION: ________________________________ DEPARTMENT: ________________________________
SIGNATURE OF APPLICANT: …………..…………………………………… DATE: ……….....……..………………………
FOR OFFICE USE ONLY
Gross Cumulative Monthly Subscriptions:
KES ………………………………
Less Administrative Fees:
KES ………………………………
Net Cumulative Monthly Subscriptions:
Less Outstanding Loan:
KES ………………………………
Net Entitlement Due to the Member:
KES ………………………………
MEMBERSHIP WITHDRAWAL ACCEPTED: ………………………...
__________________
CHAIRMAN
_____________________
SECRETARY GENERAL
CHEQUE NO.: ……………………………
________________
TREASURER
NB: Kindly attach the latest pay slip indicating your cumulative monthly subscriptions for quick processing of your refund

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