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Full Business Name

KRA Pin/ Alien ID

Gender

Male Female

Kenyan ID

Residential Town

Postal Address

City

Telephone Number

Mobile Number

Email Address

Date of Birth

Country of Birth

Permanent Address

Marital Status :

Married Single Widow / Widower

old code

Name of Next of Kin

Relationship

Kin's Mobile Number

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How long have you been residing at your current town ?

Number of years

If its less than two years, provide previous town of residence

Previous Town Of Residence

Bank

Branch

Account Number

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Current studies, diplomas & courses taken	Institution

Name of Employer	Address of Employer	Tel No	Position Held	Employment Start Date	Employment End Date	Name of Immediate Supervisor	Reason for Leaving