L – BARAZA

LAND FOR CASH MULTI CONTRIBUTORS(#7)

Select Number of Merging Contributors

None

Personal Information:

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Contributor 1 - First Name:

Contributor 1 - Last Name:

Contributor 2 - First Name:

Contributor 2 - Last Name:

Contributor 3 - First Name:

Contributor 3 - Last Name:

Contributor 4 - First Name:

Contributor 4 - Last Name:

Contributor 1 - E-mail:

Contributor 2 - E-mail:

Contributor 3 - E-mail:

Contributor 4 - E-mail:

Contributor 1 - Phone/Mobile:

Contributor 2 - Phone/Mobile:

Contributor 3 - Phone/Mobile:

Contributor 4 - Phone/Mobile:

Contributor 1 - Gender:

Male

Female

Contributor 2 - Gender:

Male

Female

Contributor 3 - Gender:

Male

Female

Contributor 4 - Gender:

Male

Female

Contributor 1 - Date of Birth:

Contributor 2 - Date of Birth:

Contributor 3 - Date of Birth:

Contributor 4 - Date of Birth:

Contributor 1 - Address Line 1

Contributor 1 - Address Line 2

City

State

Country

Contributor 2 - Address Line 1

Contributor 2 - Address Line 2

City

State

Country

Contributor 3 - Address Line 1

Contributor 3 - Address Line 2

City

State

Country

Contributor 4 - Address Line 1

Contributor 4 - Address Line 2

City

State

Country

Profile Details:

Contributor 1 - ID/File Number:

Contributor 2 - ID/File Number:

Contributor 3 - ID/File Number:

Contributor 4 - ID/File Number:

Profiled Amount for Contributor 1:

Profiled Amount for Contributor 2:

Profiled Amount for Contributor 3:

Profiled Amount for Contributor 4:

Total Combined Profiled Amount:

Estimated Combined Land Size in M2:

Branch For Contributor 1:

Branch For Contributor 2:

Branch For Contributor 3:

Branch For Contributor 4:

Date / Time:

Land Document Name To Be Used

Attestation:

Please check the box to accept.

We hereby aver as follows;

1. That the land for cash exchange represent our final payment for the contribution we made to Baraza Multi-purpose Cooperative Society Ltd. as members.

2. That our consent to this land for cash exchange option is voluntarily made.

3. That by this consent, Baraza Multi-purpose Cooperative Society Ltd. fulfill her obligation to us and no longer owe any fund whatsoever.

4. That by this consent, Baraza Multi-purpose Cooperative Society Ltd. Fulfull her obligation to us and no longer owe any fund whatsoever.

5. That we signed this document conscientiously without any form of inducement howsoever.