KN Global Holdings Shareholder Information Request Form

Your Name (as listed on official documents):*

First NameMiddle NameLast Name

Your E-mail*

example@example.com

Your Alternate E-mail

example@example.com

Your Phone Number*

Area CodePhone Number

Your Occupation *

For Kenya Government regulatory purposes, and more specifically in order to comply with shareholder stipulations as outlined in the Kenya Companies Act, the front and back of your Kenyan ID/Passport and your KRA Pin are required. To ensure that KN Global Holdings meets this regulatory requirement, we have provided this secure form to enable you to submit the required information and documents/images. These documents are required from each individual shareholder. Your timely cooperation is highly appreciated.

Please indicate your KN Global Holdings ID Number

(this is typically also the same number as your website login username/number)

Source of invested funds : *

Your Postal Address and Postal Code:*

Your Home/Physical Address:*

Street Address (Name of Estate and Street/Road/Avenue if in Kenya)

Apartment # or Suite # (House # and LR# if in Kenya)

CityState / Province

Postal / Zip Code

Please click below to upload a PDF/screenshot/scanned document showing the FRONT SIDE IMAGE of Your Kenyan ID/Passport... **

(For Kenyan citizens, upload the front and back of your Kenyan ID. For non-Kenyan citizens, upload the front and back of your Passport)

Please click below to upload a PDF/screenshot/scanned document showing the BACK SIDE IMAGE of Your Kenyan ID/Passport... **

(For Kenyan citizens, upload the front and back of your Kenyan ID. For non-Kenyan citizens, upload the front and back of your Passport)

Please click below to upload your KRA PIN as a PDF/screenshot/scanned document:*

Please type your KRA pin number in full: *

HOW TO TAKE A PASSPORT PHOTO:

Take a clear image of your face. Do not use filters commonly used on social media.
Have someone else take your photo. No selfies.
Take off your eyeglasses for your photo to reduce glare.
Use a neutral background with a plain white or off-white background being preferred.

Upload/scan a PASSPORT SIZE PICTURE of yourself:*

Please indicate the Name of your Next of Kin (Beneficiary):*

First NameMiddle NameLast Name

Please indicate the Email Address of your Next of Kin (Beneficiary):*

example@example.com

Your Next of Kin (Beneficiary) Phone Number:*

Area CodePhone Number

Please indicate the Residential Address of your Next of Kin (Beneficiary):*

Street Address (Name of Estate and Street/Road/Avenue if in Kenya)

Apartment # or Suite # (House # and LR# if in Kenya)

CityState / Province

Postal / Zip Code

Next of Kin Postal address and Postal Code:*

I hereby agree to inform KN Global Holdings in writing (or via this form) whenever there is any change in the information provided in this form.I certify under penalty of perjury that the content and files submitted on this form are true, complete and accurate to the best of your knowledge and belief.

Please verify that you are human*

Your Signature:*

KN Global Holdings Shareholder Information Form