Print This Form
PART-WITHDRAWAL FORM  


Affix two passport
photographs with your
name @ the back.

       
SURNAME…………………………………… OTHER NAMES………………………………........................
ORACLE NO……………………..…………... MEMBERSHIP NO ………………………….........................
MDA ADDRESS  ………………….……..………............................................................................................................  
OFFICE/SCHOOL …………………………………………………………………………..………………....................
AMOUNT APPLIED ……………………………………………………………………………………..……………………...
TOTAL DEDUCTION ..……………………………………………………………………………………………..……………
NET PAY (attachment of recent payslip) ………….………………………………………………………… (compulsory)
E-Mail ADDRESS ………………………………………………………………………..…………………Tel No .………………..........
NEXT OF KIN ………………………………………………………………………………Relationship ……….....................................
ADDRESS ……………………………………………………………………………….. PHONE No …………………………….........
I ………………………………………………………………..hereby authorize the above named society to deduct my outstanding debt from my salary for 18 months (maximum repayment period), with effect from the month of …………………… to ……………

……………………………………………………………….
            Signature and Date

 

CAVEAT EMPTOR
PLEASE ALL PAYMENTS MUST BE MADE TO THE SOCIETY’S BANK ACCOUNT
Note:  Attach your current payslip.
                                                     FOR OFFICE USE ONLY

………………………………………………………                                                            ……………………………………………………………
Secretary’s Signature and Date                                                                      Treasurer’s Signature and Date
(Applicant with amount above N200,000.00 should attached letter of employment)