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CUSTOMER REGISTRATION

BASIC DETAILS:   First Name:    (*) Middle Name:   Surname:    (*) Occupation:    (*) E-mail:    (*)   CONTACT ADDRESS:   Physical Address:  (*) P.O. Box: Postal Code: City/Town:  (*) County:   SELECT ONEBaringoBometBungomaBusiaElgeyo-MarakwetEmbuGarissaHoma BayIsioloKajiadoKakamegaKerichoKiambuKilifiKirinyagaKisiiKisumuKituiKwaleLaikipiaLamuMachakosMakueniManderaMarsabitMeruMigoriMombasaMurang'aNairobiNakuruNandiNarokNyamiraNyandaruaNyeriSamburuSiayaTaita-TavetaTana RiverTharaka-NithiTrans-NzoiaTurkanaUasin GishuVihigaWajirWest Pokot Country: Kenya

TELEPHONES:   Mobile number:   Prefix:  +254   Number:    (*) Home number:   Prefix:  +254   Number:   Office number:   Prefix:  +254   Number:   BANK ACCOUNT: (*)   Bank: NONE Other Jamii Bora Bank ABC Bank Bank of Africa Bank of Baroda Bank of India Chase Bank Citibank Consolidated Bank of Kenya Cooperative Bank of Kenya Credit Bank Development Bank of Kenya Diamond Trust Bank Dubai Islamic Bank Ecobank Kenya Equity Bank Family Bank First Community Bank Guaranty Trust Bank Kenya Cooperative Bank of Kenya Guardian Bank Gulf African Bank Habib Bank AG Zurich Housing Finance Company of Kenya I&M Bank Imperial Bank Kenya Kenya Commercial Bank Mayfair Bank Middle East Bank Kenya M Oriental Bank National Bank of Kenya NCBA Bank Kenya Paramount Universal Bank Prime Bank (Kenya) SBM Bank Kenya Limited Sidian Bank Spire Bank Stanbic Bank Kenya Standard Chartered Kenya Transnational Bank United Bank for Africa Victoria Commercial Bank Branch:   Account number:     IDENTIFICATION:  (*)   ID Number:   or Passport:     Gender:   Male Female Date of Birth:   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 January February March April May June July August September October November December 2018 2017 2016 2015 2014 2013 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 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919

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