Online Individual Registeration
INDIVIDUAL REGISTERATION
Name
*
Address
*
Country
COUNTY NAME
SUB COUNTY
PHYSICAL ADRESS
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Gender
*
Please Select
Male
Female
Others
Maritual status
*
Please Select
SINGLE
MARRIED
DIVORCED
WIDOWER
WIDOW
Email {Personal}
*
example@example.com
Branch Code
*
Please Select
KIBERA
MUKURU KWA NJENGA
KAWANGWARE
MATHARE
MOMBASA
KAKAMEGA
MACHAKOS
MAKUENI
KISII
MERU
SIAYA
WESTERN
Phone Number
*
Format: (254) 000-0000-00.
Share Capital Monthly
*
Max Share Capital
*
Next of kin Details
Contact Person Name
*
Gender
*
Please Select
Male
Female
Others
ID Number
*
Phone Number
*
Please enter a valid phone number.
Format: (254) 000-0000-00.
Relationship
*
Please Select
FATHER
MOTHER
SON
DAUGHTER
GRAND DAUGHTER
GRAND SON
SON INLAW
DAUGHTER INLAW
FRIEND
BROTHER INLAW
SISTER INLAW
FATHER INLAW
MOTHER INLAW
GRAND FATHER
GRAND MOTHER
COLLEAGUE
BROTHER
SISTER
Nominee information
*
Rows
NAME
ID NUMBER
RELATIONSHIP
CONTACT
DATE OF BIRTH
%
1
2
3
4
APPLICANTS SIGNATURE
EFFECTIVE DATE
*
-
Month
-
Day
Year
PROVIDE YOUR SIGNATURE
*
TAKE A PHOTO OF THE APPLICANT
*
UPLOAD YOUR ID COPY
*
Browse Files
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Choose a file
Cancel
of
UPLOAD YOUR KRA PIN COPY
*
Browse Files
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Cancel
of
INPUT THE MPESA CODE AFTER PAYING
*
Submit
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