CORPORATE MEMBERSHIP APPLICATION FORM (PLEASE TYPE IN)

APPLICANT INFORMATION

Name of Organization:

Sector:

Postal Address:

Postal Code:

Telephone Number:

Number of employees:

Details for Key Contact Person in the Organization

Name of Key Contact Person:

Title:

Office Telephone:

Personal Mobile Contact:

Email Address:

MEMBERSHIP CATEGORY & FEES(Tick as Appropriate:)

Corporate Member:

• Joining Fee: KES 55,000
• Annual Subscription: KES 45,000

PAYMENT METHOD (HIGHLIGHT AS APPLICABLE)

MPESACASHCHEQUE

PAYMENT DETAILS

1. All payments by cheque should be written to the Institute of Customer Service Kenya Limited.
2. Direct transfers should be made to : Institute of Customer Service Kenya Limited , DTB ,
Wabera Street Branch , Account Number: 0243424001 Bank Code :063
3. Lipa Na M-PESA: Till Number: 880879
4. Membership Certificate will be issued 2 weeks from date of payment.
5. Membership certificate is renewable annually

COMMITTMENT

We wish to apply for corporate membership of ICX Kenya and undertake to promote its aims and
objectives, and abide by its rules and regulations.

SIGNATURE:
DATE:

FOR OFFICIAL USE ONLY

Corporate Membership Number:

Date of Admission:

Date of renewal: