Application

Application Form

Name*
First Last
Phone*
Email*
ID/Passport Number*
Occupation*
2. RESIDENTIAL DETAILS
Address*
Building/ Apartment name and number City/Town
3. ITEM
Item description*
Market value (Kes)*
Store Name*
Where was this device purchased?
Serial/ IMEI number (if applicable)*
Attach receipt (image/ scan)
Consent*
I agree to the terms & conditions
Refreral URL
UTM TRACKER
Name
This field is for validation purposes and should be left unchanged.