Mbaitu Inc. Membership

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Membership Registration

Member Full Name: *

Email *

Tel *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Covered Members Plus Principle:

Principle member: *

Spouse Name

First

Last

Nuclear Members

Father

First

Last

Mother

First

Last

Do you have children? *

Do you have Siblings? *

Mbaituinc. Covers 7 family members from these categories principle member, parents, nuclear family and siblings. In the event that the above categories do not make seven in your case. Notify any of the officials and they will guide you on how to add any in the below category. Shared scenarios will be treated as one case. So if you join as family members you have to agree either to share the money when a shared scenario occurs or to pick different family members.

Adopted children:

Name

Grandparents:

Name

Uncle/Aunt:

Name

Other:

Name

I have received and read the hand book, I have also made the one time membership amount of $200, I also promise to replenish in a timely manner otherwise missing 3 occurrences will mean that I am no longer a member of the welfare.

N/B:

1. Please note that membership amount only applies to the new members.

2. Per cycle a member can only cover 7 members of the family after which renewal of membership is required

Addendum Section *

I have read the addendum, signed and notarized a copy which I have emailed to the Mbaitu inc. Welfare or uploaded in the website.

Addendum Upload

Click or drag a file to this area to upload.

Upload a signed and notarized copy of addendum

Kindly sign below:

I have completed and submitted a notarized addendum:

Date / Time *

To notify treasurer of an occurrence, deposit before travel for cases that may occur while you are away, suggestions email: mbaituincwelfare@gmail.com

1) Treasurers Contact: Daudi Mbuta: 6166350408
2) Communications: Ree Ndunge: 8622150615

Checkboxes *

I understand that I should replenish for each case in the two week period failure to which fees will apply, while not in good standing meaning I have not replenished in the 2 week period I will not qualify for the welfare benefits

Checkboxes *