Benevolence Enrollment

Benevolence Fund Enrollment

Kenya Houston Community Benevolence Fund (KHCBF) offers assistance to members and their families who are faced with bereavement. If you would like to enroll please complete the form below to submit your application.

Please review the organization's KHCBF bylaws before completing your application.

1. Member Information

2. Beneficiaries & Covered Members

3. Finalize

YOUR INFO

This should be your legal name as it appears on your government ID.

* First Name

Middle Name

* Last Name

Suffix

YOUR CURRENT ADDRESS

* Street Address

* City

* State

Suite or Apartment #

* Zip Code

* Country

YOUR CONTACT INFO

* Email Address Email is required. Invalid email address.

* Prefered method of communication

Text

* Cell Phone Number

BENEFICIARIES INFO

Enter names of your beneficiaries and percentage allocation you'd like to include your membership. A beneficiary is a person or entity you designate to receive the proceeds of your account after your death. Percentage allocation cannot exceed 100%

(Total beneficiary percentages should equal 100%)

* Beneficiary First Name

Beneficiary Middle Name

* Beneficiary Email Address

*Beneficiary Last Name

* Percentage Total beneficiary percentages should equal 100%

* Relationship

* Beneficiary Cell Phone

* Beneficiary First Name

Beneficiary Middle Name

* Beneficiary Email Address

*Beneficiary Last Name

* Percentage Total beneficiary percentages should equal 100%

* Relationship

* Beneficiary Cell Phone

* Beneficiary First Name

Beneficiary Middle Name

* Beneficiary Email Address

*Beneficiary Last Name

* Percentage Total beneficiary percentages should equal 100%

* Relationship

* Beneficiary Cell Phone

* Beneficiary First Name

Beneficiary Middle Name

* Beneficiary Email Address

*Beneficiary Last Name

* Percentage Total beneficiary percentages should equal 100%

* Relationship

* Beneficiary Cell Phone

* Beneficiary First Name

Beneficiary Middle Name

* Beneficiary Email Address

*Beneficiary Last Name

* Percentage Total beneficiary percentages should equal 100%

* Relationship

* Beneficiary Cell Phone

Add Beneficiary

COVERED FAMILY MEMBERS

Enter names of your family members who should be covered as referenced in our bylaws, article 3:3 Membership.

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

*First Name

*Last Name

* Relationship

Add Covered Member

DIGITAL SIGNATURE

* Print Your Name Here

* Date Signed

* Check this box to confirm that all information provided is true and you have reviewed and agree to the KHCBF bylaws.