ACK St. Paul’s Jamhuri Parish Welfare Registration

Section A

Principal Member Details

Full Name

Gender

Male Female

Date of Birth National ID Number Phone Number Email Address Postal Address

Other Church Department

Marital Status

Single Married Widowed Other

Documents Submitted — Principal Member

ID National ID Copy Required · PDF or image 📷 Passport Photo Required · image

Section B

Children Details

Children are optional. Add up to five children, and upload a birth certificate for each child added.

Section C

Parents Details

Father

Name Date of Birth National ID Number Phone (if available)

ID National ID Copy Optional 📎 Other Supporting Document Optional

Mother

Name Date of Birth National ID Number Phone (if available)

ID National ID Copy Optional 📎 Other Supporting Document Optional

Section D

Parents-in-law Details

This section appears only for married members.

Father-in-Law

Name Date of Birth National ID Number Phone (if available)

ID National ID Copy Optional 📎 Other Supporting Document Optional

Mother-in-Law

Name Date of Birth National ID Number Phone (if available)

ID National ID Copy Optional 📎 Other Supporting Document Optional

Section E

Next of Kin / Nominee Details

Nominee Name Relationship to Member Phone Number ID Number

Documents Submitted — Next of Kin / Nominee

ID National ID Copy Required · PDF or image

Section F

Contribution Details

Monthly Contribution

Payment Method

M-Pesa Paybill Bank Transfer

Date of First Contribution

Member Added to Welfare WhatsApp

Yes No

Section G

Declaration

I confirm that the information provided above is accurate and agree to abide by the ACK St. Paul’s Jamhuri Welfare Constitution and Rules.

Member Signature / Typed Full Name Date

Welfare Registration

Principal Member Details

Spouse Details

Documents Submitted — Principal Member

Children Details

Parents Details

Father

Mother

Parents-in-law Details

Father-in-Law

Mother-in-Law

Next of Kin / Nominee Details

Documents Submitted — Next of Kin / Nominee

Contribution Details

Declaration

Child