Firstname:

Surname:

Other Names:

Email Address:

Telephone (1):

Telephone (2):

Residential Address: Rented     Owned      Family Inherited

Postal Address:

Day of Birth: -Select- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Month of Birth: -Select- January February March April May June July August September October November December

Year of Birth: -Select- 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930>

Gender: -Please select- Male Female

Marital Status: -Please select- Married Not married Seperated Widowed

Highest Education:

Number of Children:

Males:

Females:

Age of the Youngest(years):

Age of the Oldest(years):

Number of Other Dependants:

Name of Closest Relative:

Relationship Type(e.g. Wife, Husband):

Phone Number:

BMI (Body Mass Index) in kg/m²:

Average Daily Blood Pressure ( __/__mmHg ):

Fasting Blood Sugar:

2HPP Blood Sugar:

When last did Health Check?

What were the issues found?

Address of Place of Business:

Kind of Business (Please describe what you do in the space below):

State your current business Net Worth (=N=): NOTE: NET WORTH IS (CASH + VALUE OF STOCK + VALUE OF PHYSICAL ASSETS + AMOUNT OWED BY DEBTORS) – (AMOUNT OWED TO CREDITORS + DOUBTFUL DEBTS OF DEBTORS)

State your current Trading Capital (=N=): NOTE: CALCULATE TRADING CAPITAL AS (BUSINESS CASH + VALUE OF STOCK + AMOUNT OWED BY DEBTORS) – (AMOUNT OWED TO CREDITORS + DOUBTFUL DEBTS OF DEBTORS)

State your current Cash in Hand (=N=): NOTE: CALCULATE CASH IN HAND AS (BUSINESS CASH IN BANK + CASH IN HAND)

As of Date:

When Did You Start this Business?:

Seed Capital Started with (=N=): NOTE: : CALCULATE CASH STARTED WITH AS (YOUR OWN MONEY + MONEY BORROWED + FAMILY AND FRIEND)

State your Average Daily Turnover(Sales Figure) in the last 6 months: NOTE: CALCULATE AVERAGE TURNOVER AS (AMOUNT OF SALES OVER THE 6 MONTHS DIVIDED BY THE NUMBER OF WORK DAYS IN THE 6 MONTHS)

State your Average Daily Turnover in the last 1 month: NOTE: : CALCULATE AVERAGE TURNOVER AS (AMOUNT OF SALES OVER THE MONTH DIVIDED BY THE NUMBER OF WORK DAYS IN THE MONTH)

Neighbour Reference 1 Name:

Telephone:

Neighbour Reference 2 Name:

Telephone:

Beulah Destiny Club (BDC) engages in educating its members in growing wealth. BDC actively prays for its members’ success, and in the name of Jesus Christ only. We are not opposed to admitting people of non-Christian religions, but people who elect to join BDC must be willing to abide in its believes, values and practices, including Christian religious practices. The following questions are about your religious affiliations.

Are you a Christian? Yes    No

What is your religious affilliation if you are not a christian?

Are you willing to accept BDC's values, beliefs, and practices as stated in its handbook? Yes    No

What is the name of your Church?

Is your pastor willing to recommend you to be a member of BDC? Yes    No

Is your pastor willing to also be a surety for you? Yes    No

ATTESTATION:
  I CONFIRM THAT I HAVE READ AND UNDERSTAND THE REQUIREMENTS FOR BECOMING A MEMBER OF BEULAH DESTINY CLUB. I ALSO CONFIRM THAT ALL INFORMATION I HAVE SUPPLIED ABOVE ARE CORRECT; THEY DO NOT CONTAIN ANY FALSEHOOD OR HALF TRUTHS. I UNDERSTAND THAT IF BEULAH DESTINY CLUB SHALL LATER FIND ANY INFORMATION THAT I HAVE SUPPLIED TO BE FALSE OR INTENTIONALLY MISLEADING I MAY BE DEREGISTERED AS A MEMBER OF BEULAH DESTINY CLUB.

Recommended by(Current member of BDC):

Member's Number: