Application Application Form Name* First Last Phone*Email* ID/Passport Number*Occupation*2. RESIDENTIAL DETAILSAddress* Building/ Apartment name and number City/Town 3. ITEMItem 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 & conditionsRefreral URLUTM TRACKERNameThis field is for validation purposes and should be left unchanged.