Kenyans In South Wales Member Detail Forms

Member Reference Number

Group Name

Group Number

Title

First Name

Last Name

Middle Name

Identification Type

Identification Number

Date of Birth

Gender

Country Of Residence Of Main Member

City Of Residence Of Main Member

Physical / Postal Address

Phone

Family Option

Dependant Details

Beneficiary / Next of Kin Details

Add Beneficiary / Next of Kin Details in order of priority

Payment Information

Account Name: CITYBOXCOURIERS

Account Number: 70161909

Short Code: 55 50 28

Please Deposit to the Birdview Partner Collection Account

⚠️ Please use your Member Reference Number as the Reference Number when making the payment.

⚠️ Policy will be Effective upon receipt of Funds.Please upload proof of Payment

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