Академический Документы
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(Please read the Terms and Conditions of MLAMU Health Savings and Loans Service available at MLAMU Service Centers/Agents
or at www.mlamu.com before filling out this Form)
1. PERSONAL DETAILS
Surname:
2. Contact details:
3. EMPLOYNMENT Profession:______________________________
Name: Relationship:
A .…………………………………………………………………………. B…………………………………………………………………..
UGX………………………………………………………………….Per year.
Do you (or any close relative) hold a senior government position (Uganda/foreign) or government institutions, Agency, Entity? YES NO
YES NO
10. Provide Bank account of Mobile money number on which your funds will be sent
c) Statement delivery
EMAIL TO COLLECT
DECLARATION
Service Level Partners:
I have read and been explained the Terms and Conditions which I have accessed. I understand that by entering into this agreement, I give indemnities,
authorizations, consents and waivers and agree to limitations on the organizations liabilities. I do hereby affix my signature as evidence that I fully understood
and agree to be bound by same. I agreed to be bound by any variations to the terms and conditions that may be made by the organizations from time to time
and to any updated versions on the website: www.mlamu.com
Name: _______________________________________
Signature:__________________________________
Date: _______________________________________
KEY FACTS AND CONDITIONS ABOUT MLAMU HEALTH SAVINGS & LOANS SERVICE. (PLEASE ONLY SIGN AFTER YOU HAVE READ, UNDERSTOOD
AND AGREED TO THE TERMS & CONDITIONS OF THIS SERVICE)
KEY BENEFITS
a) Secure and convenient way to make Health/Emergency Savings and to grow your savings habit.
b) Access a to Healthcare/ emergency loan secured against your savings of up to 3 times the amount you have saved with a maximum of UGX 500,000 .
c) Ability to withdraw or share with loved ones part of your savings anytime.
HOW TO DEPOSIT MONEY ONTO YOUR ACCOUNT: You can pay money into your account in any of the following ways; Over the Counter through KCB Bank
Branches, Cash Deposits at MLAMU Service Centers/Agents, Bank Transfers and Standing Orders, USSD (through Mobile Money Networks like MTN & Airtel) or
as will be communicated from time to time.
Tax implications: Withholding tax/excise duty where applicable will be charged and debited off your account.
Account Closure: You may close your account at any time after 3months of saving. To close your account, you will have to put it in writing and there will be a
charge of 1% of your savings if you have held the account for less than 1 year or the funds have not been in the account for 1 Year.
Future communications
It’s important to for us to be able to communicate with you from time to time. Blow, please tick at least two preferred means of communication and provide
details (update us in case of any changes.
Contact Phone
Whatsapp Phone No.
Email
Other
Client’s Name:…………………………………….Client’s Signature: ………………………………………………………
Date:……………………………………………………………………..