RIVERSIDE WOMEN GROUP
KIDFARMACO ESTATE, KIKUYU.
(To be completed in duplicate)
Original - RWG Custody.
Copy Member File.
MEMBER'S NEXT OF KIN DETAILS
1.0.
Notes
a).
b).
c).
d).
The next of kin will automatically assume the role of a legal personal
representative.
Relationship means Husband/Wife/Son/Daughter/Father/Mother, etc.
Any changes on the member's record should be immediately communicated
by the member of the RWG
Dependant means the beneficiary.
2.0.
Full member's Name
(BLOCK LETTERS)
ID/Passsport No.
3.0.
Permanent Address
4.0.
Home District: …........................................... Location: ….................................................
Sub-Location: ….................................................................................................................
5.0.
a
I, Mrs/Miss/Dr…............................................ ID NO. ….....................................hereby
nominate the following as my next of kin and dependants:Next Of Kin
Name
1
2
3
4
5
6
7
8
9
10
sex
age
Relationship
ID No.
Address
Tel. No.
RIVERSIDE WOMEN GROUP
a
Dependants
Name
sex
age
Relationship
ID No.
Address
Tel. No.
1
2
3
4
5
6
7
8
9
10
I confirm that this nomination cancels and supersedes any previous nomitions.
Dated at this ….................................day of ….........................20…...............................................
SIGNED by the said…..........................................)
….......................................................................)
….......................................................................)
in the presence of…...........................................)
….......................................................................)
DATE …..............................................................)