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VARIATION FORM

I MR/MRS/MISS…………………………………………………………………………. EMP|TSC. NO……………………………….

M/NO…………………………………… WORK STATION………………………………… MOBILE PHONE NO……………………………

REQUEST TO INCREASE DECREASE (TICK ONE)

1. MONTHLY DEPOSITS FROM KSHS………………………..……….… TO KSHS………………………………………………


2. LOAN REPAYMENT FROM KSHS……………………………………... TO KSHS……………………………………………....
3. CHRISMAS SAVINGS FROM KSHS……………………………………. TO KSHS………………………………………...….…
4. EXCEL SAVINGS FROM KSHS…………………………..……………….. TO KSHS…………………………………………….…
5. MEDICARE SAVINGS FROM KSHS………………………………….…. TO KSHS………………………………………………..
6. RISK COVER FROM KSHS…………………………………………….…… TO KSHS ………………………………………..………..
TOTAL KSHS……………………………………..

WITH EFFECT FROM THE MONTH OF ………………………………………….. UNTIL FURTHER NOTICE

APPLICANTS SIGNATURE……………………………………………… DATE……………………………………….

FOR OFFICIAL USE

ACTIONED BY:

NAME…………………………………………………………………………………….DATE……………………………………………………………

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