AMA Membership Membership Application FormOrganization Name: *Director's Name: *Address: *Website: Phone: *Email: *Organization Registered With: *Dated: *Type of Services: Financial Activities Start Date: Legal Form: Nature of Work: *MFIMFBFICSPIOtherGeographical Coverage (provinces): Financial Services: CreditSavingInsuranceOtherNumber of Clients: Number of Women Clients: Loan Portfolio (USD): Operating Model: Number of Employees: Organization's Orther Major Activities: Collaborations/linkages with other institutions (Donor, Bank, Govt., NGO, Network): Declaration from the ApplicantMembership: *I hereby certify that the information furnished in the application form is true to the best of my knowledge. On behalf of our organisation, I am authorised to and hereby applying for the Membership of AMA. We understand and agree to abide by the rules (subject to change from time to time), regulations of AMA and sector code of conduct. We agree to pay the annual membership fee as applicable which is non-refundable (after approval of membership).CertifiedNot CertifiedReporting: *I hereby declare that our organization will comply-with the reporting requirements of AMA pertaining to Side by Side report, Quick report, standards, Code of Conduct, Social Performance and any other information as per the requirement.DeclaredNot DeclaredDeclaration: *I hereby declare that our organization is a law abiding organization and no defraud cases are ever lodged against us.DeclaredNot DeclaredDeclaration: *I hereby declare that our organization will actively follow / promote / encourage/ display in all the offices adherence of AMA standards and Code of Conduct.DeclaredNot DeclaredRepresentation We nominate the following as ‘Empowered Representative’, who will participate in the meetings and other network business of AMA on behalf of our organization.Name | Position | Email | PhoneAttachmentsCompany License: List of Members of the Board: Company Byelaws: Latest Annual Report: (if any) VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank: