BLACK ROYALTY STOKVEL CLUB MEMBERSHIP FORM

BLACK ROYALTY STOKVEL CLUB MEMBERSHIP FORM
BULAWAYO/HARARE CHAPTER
Membership number
Take a headshot from shoulders up *
Names*

First NameSurname
Residential Address*
DOB*
Marital Status
Email*
example@example.com
Phone Number*

Area CodePhone Number
Number of Dependents
Optional
Names

First NameSurname
ID Number of Dependent
Names

First NameSurname
ID Number of Dependent
Names

First NameSurname
ID Number of Dependent
Names

First NameSurname
ID Number of Dependent
Names

First NameSurname
ID Number of Dependent
All prospective members are required to complete this registration for and return it with payment prior to selection or categories

NB : Please that all membership fees paid are non-refundable
Spouses details
Full Names
Phone Number *
ID Number *
Employers Details
Contact Details
Details of next of kin (Other than Spouse)
Full Name*
Address*
ID Number*
Phone Number(s)*
Section D: Declaration by Applicant

I declare that any false information in the above section or non-disclosure of material information will render the membership null and void
Applicants Signature*

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Date*

MonthDayYear
Date
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