Diaspora Online Registration

Diaspora Online Registration Form

Diaspora Online Member Registration

Select Title *

Surname *

Gender. *

Nationality *

If you select Other ( Specify)

First Name (s) *

Marital Status

Date of Birth. *

ID/ Passport No. *

Issue Date (if Passport)

PIN NO.

Current Address

State *

Email Address *

Expiry Date (if Passport)

Country of Residence *

City *

ZIP Code *

Telephone No. *

PAYMENT INSTRUCTIONS

I here by commit to credit USD ($) to LAPFUND Bank Account *

Date of Commencement of Contributions *

Specify date of Credit

BANK ACCOUNT DETAILS OF LAPFUND

Account Name	Account No.	Bank	Branch	Swift Code
Local Authorities Provident Fund	1114898767	KCB	Gateway House	KCBLKENX

Forward payment information to diaspora@lapfund.or.ke

NOMINATED BENEFICIARIES

1st Beneficiary

1st Beneficiary Full Name *

1st Beneficiary ID/ Passport No. *

1st Beneficiary Telephone No.

Relationship with 1st Beneficiary (if Any) *

1st Beneficiary Email Address *

Proportion of Benefit for 1st Beneficiary (%) *

2nd Beneficiary

2nd Beneficiary Full Name.

2nd Beneficiary ID/ Passport No.

2nd Beneficiary Telephone No.

Relationship with 2nd Beneficiary (if Any).

2nd Beneficiary Email Address.

Proportion of Benefit for 2nd Beneficiary (%).

IF YOU WERE RECRUITED BY AN AGENT, KINDLY SELECT HIS NAME:

Agent Name: *

FORM OF COMMUNICATION

Please tick how you would like to receive communications such as Statements, Updates etc.

DECLARATION: I the undersigned confirm that i have read and understood this declaration and its implications

Applicant Name *

Upload Beneficiaries ID /Passport:

Select files...

Application Date: *

Upload Applicant ID/ Passport *

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Send me a copy

Membership

Vision & Mission

Vision: The preferred savings and retirement benefits provider.

Msision: To receive, prudently invest and manage members’ contributions for prompt payment of benefits for secured retirement.

CORE VALUES:IntegrityProfessionalismTeamworkCustomer FocusContinuous Improvement