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Paybill No:
830300
Online User Profile
Ref. -
1.
Registration Details
*
from registrar of companies for new applicants
Fill all details. Fields marked with
*
are mandatory before saving this form.
Registered Name:
*
Ownership Type:
*
Individual
Partnership
Company
Bancassurance
Business Type:
*
Agent
Certificate of Registration:
2.
Contact Details
Main Office:
*
Physical Location:
P.O. Box Number:
*
*
must be numeric
Telephone Number (s):
Town / Postal Code:
*
Adungosi - 50413
Ahero - 40101
Ainabkoi - 30101
Akala - 40139
Amagoro - 50244
Amalo - 20424
Amukura - 50403
Asumbi - 40309
Athiriver - 00204
Awasi - 40122
Bahati - 20113
Bamba - 80101
Bamburi - 50316
Banja - 50411
Baragoi - 20601
Baraton - 30306
Baricho - 10302
Bissel - 01101
Bokoli - 50206
Bomet - 20400
Bondeni - 20101
Bondo - 40601
Booker - 50137
Boro - 40620
Brigadier - 50245
Bukura - 50105
Bulimbo - 50109
Bumala - 50404
Bungoma - 50200
Bura Tana - 70104
Burnt Forest - 30102
Busia - 50400
Butere - 50101
Butula - 50405
Buyofu - 50210
Chamakanga - 50302
Changamwe - 80102
Chavakali - 50317
Chebiemit - 30706
Chebunyo - 20401
Chemaner - 20407
Chemelil - 40116
Chepareria - 30605
Chepkoilel - 30133
Chepkorio - 30129
Cheptais - 50201
Chesinendet - 20217
Chiakariga - 60409
Chogoria - 60401
Chuka - 60400
Chumvi - 90147
Chumvini - 80314
Chwele - 50202
Coast General Hospital - 80103
Dadaab - 70103
Dago - 40112
Daraja Mbili - 40117
Daystar University - 90145
Diani Beach - 80401
Docks - 80104
Doldol - 10401
Donyo Sambuk - 01027
Egerton - 20115
Ekalakala - 90139
Elburgon - 20102
Eldama Ravine - 20103
Eldoret - 30100
Elwak - 70301
Emali - 90121
Embu - 60100
Emuhaya - 50314
Endarasha - 10107
Endebess - 30201
Etago - 40208
Faza - 80501
Fort Ternan - 20209
Funyula - 50406
Gacharageini - 10210
Gaitu - 60209
Gakere Rd - 10109
Gakindu - 10111
Gakungu - 10239
Gambogi - 50318
Garbatulla - 60301
Garissa - 70100
Garsen - 80201
Gathugu - 00240
Gatitu - 10114
Gatukuyu - 01028
Gatundu - 01030
Gatunga - 60404
Gatura - 01013
Gede - 80208
Gesima - 40503
Gesusu - 40201
Giakanja - 10108
Gikoe - 10213
Gilgil - 20116
Githongo - 60205
Githunguri - 00216
Gitimene - 60212
Gituamba - 01003
Gitugi - 10209
Gongoni - 80206
Griftu - 70202
Hamisi - 50312
Hawinga - 40640
Hebaswein - 70201
Hola - 70101
Homa Bay - 40300
Huruma - 30109
Igare - 40209
Igoji - 60402
Igwamiti - 20307
Iiani - 90120
Ikalaasa - 90135
Ikonge - 40501
Ikutha - 90207
Ikuu - 60405
Ishiara - 60102
Isibania - 40414
Isiolo - 60300
Iten - 30700
Ithanga - 01015
Jkia - 00501
Kabarak - 20157
Kabarnet - 30400
Kabartonjo - 30401
Kabati - 90205
Kabazi - 20114
Kabianga - 20201
Kabiyet - 30303
Kacheliba - 30601
Kadogo - 40223
Kagio - 10306
Kagumo - 10307
Kagunduini - 1033
Kagwe - 00223
Kaheho - 20304
Kahuhia - 10206
Kahuro - 10201
Kaimosi - 50305
Kajiado - 01100
Kakamega - 50100
Kakuma - 30501
Kakunga - 50115
Kalamba - 90122
Kalimoni - 01001
Kalokol - 30502
Kaloleni - 80105
Kambi Samaki - 30406
Kambiri - 50116
Kambiti - 10226
Kamukuywa - 50216
Kamuriai - 50408
Kamuwongo - 90403
Kandara - 01034
Kandiege - 40304
Kangari - 10218
Kangema - 10202
Kangundo - 90115
Kanja - 60118
Kanjuku - 01004
Kanyakine - 60206
Kapcheno - 30304
Kapcherop - 30204
Kapenguria - 30600
Kapkatet - 20214
Kapsabet - 30300
Kapsoit - 20211
Kapsokwony - 50203
Kapsowar - 30705
Kaptagat - 30114
Kaptarakwa - 30701
Karaba - 60105
Karandi - 20328
Karatina - 10101
Karungu - 40401
Karuri - 00219
Karurumo - 60117
Kasikeu - 90123
Katangi - 90106
Kathiani - 90105
Kathonzweni - 90302
Kathwana - 60406
Katito - 40118
Kaviani - 90107
Kebirigo - 40506
Kedowa - 20220
Keekerok - 20501
Kendu Bay - 40301
Kengeleni - 80122
Kenhancha - 40413
Kenol - 1020
Kenyenya - 40211
Kericho - 20200
Keringet - 20131
Keroka - 40202
Kerugoya - 10300
Kesogon - 30215
Keumbu - 40212
Khayega - 50104
Khwisero - 50135
Kiamariga - 10122
Kiambu - 00900
Kiamutugu - 10309
Kianjai - 60602
Kianjokoma - 60111
Kianyaga - 10301
Kibirichia - 60201
Kibwezi - 90137
Kiganjo - 10102
Kigumo - 10203
Kihoya - 10207
Kiirua - 60207
Kijabe - 00220
Kikima - 90125
Kikoneni - 80410
Kikuyu - 00902
Kilala - 90305
Kilgoris - 40700
Kilifi - 80108
Kilindini - 80107
Kilingili - 50315
Kimbimbi - 10310
Kimilili - 50204
Kiminini - 30209
Kimulot - 20225
Kimwarer - 30128
Kinale - 20315
Kinamba - 20320
Kinango - 80405
Kindaruma - 01031
Kinoru - 60216
Kionyo - 60211
Kipkabus - 30103
Kipkaren - 50241
Kipkelion - 20202
Kiptagich - 30402
Kiptere - 20213
Kiptugumo - 20208
Kiriaini - 10204
Kiritiri - 60113
Kiritu - 50313
Kirwara - 01018
Kiserian - 00206
Kisii - 40200
Kisumu - 40100
Kitale - 30200
Kitengela - 00242
Kithimani - 90124
Kithimu - 60114
Kithyoko - 90144
Kitise - 90303
Kitui - 90200
Kivunga - 90111
Kobujoi - 30305
Kola - 90108
Kombewa - 40102
Kondele - 40103
Kora - 40104
Kosele - 40332
Koyonzo - 50117
Kubukubu - 60125
Kutus - 10304
Kwale - 80403
Kyatune - 90220
Kyeni - 90209
Kyuso - 90401
Laare - 60601
Laikipia Campus - 20330
Laisamis - 60502
Lamu - 80500
Lanet - 20112
Langas - 30112
Lessos - 30302
Likoni - 80110
Limuru - 00217
Litein - 20210
Lodwar - 30500
Loitokitok - 00209
Loiyangalani - 60501
Lokichoggio - 30503
Lokitaung - 30504
Lolgorian - 40701
Londiani - 20203
Longisa - 20402
Luanda - 50307
Lubao - 50118
Lugari - 50108
Lugulu - 50218
Luhano - 40623
Lukusi - 50230
Lumakanda - 50242
Lunga Lunga - 80402
Lunza - 50119
Lwakhakha - 50220
Maai Mahiu - 20147
Mabusi - 50235
Machakos - 90100
Madaraka - 01002
Madiany - 40613
Madina - 80207
Magadi - 00205
Magena - 40624
Mago - 50325
Magombo - 40507
Magumoni - 60403
Magunga - 40307
Magutuni - 60407
Magwagwa - 40508
Makindu - 90138
Makongeni - 00510
Makueni - 90300
Makupa - 80112
Malakisi - 50209
Malava - 50103
Malindi - 80200
Mandera - 70300
Manyatta - 60101
Maragoli - 50300
Maragua - 10205
Maralal - 20600
Marani - 40214
Mariakani - 80113
Marigat - 30403
Marima - 60408
Marimanti - 60215
Marmanet - 20322
Marsabit - 60500
Masalani - 70105
Maseno - 40105
Mashuru - 01103
Masii - 90101
Masinga - 90141
Matathia - 00221
Matete - 50136
Matiliku - 90140
Matuga - 80406
Matunda - 30205
Matuu - 90119
Maua - 60600
Maungu - 80317
Mavindini - 90304
Mawego - 40310
Mazeras - 80114
Mbiri - 10233
Mbita - 40305
Mbitini - 90214
Mbiuni - 90110
Mbumbuni - 90127
Mchumbi Rd - 00504
Mega City - 40123
Menengai - 20104
Meru - 60200
Mfangano - 40319
Mgambonyi - 80313
Mgange - 80306
Miathene - 60604
Migwani - 90402
Mihararti - 20301
Mikinduri - 60607
Milimani - 50138
Mirangine - 20124
Mirogi - 40320
Misikhu - 50207
Mitaboni - 90104
Mitunguu - 60204
Miu - 90112
Miwani - 40106
Mkomani - 80106
Mlolongo - 00519
Modogashe - 70102
Mogogosiek - 20403
Mogotio - 20105
Moi Airport - 80115
Moi University - 30107
Moiben - 30104
Mois Bridge - 30202
Mokomoni - 40510
Mokowe - 80502
Molo - 20106
Mombasa - 80100
Mosoriot - 30307
Moyale - 60700
Mpeketoni - 80503
Msambweni - 80404
Mtito Andei - 90128
Mtongwe - 80111
Mtopanga - 80117
Mtwapa - 80109
Mubwayo - 50423
Mugunda - 10129
Muhoroni - 40107
Muhuru Bay - 40409
Mukhe - 50225
Mukurweini - 10103
Mumias - 50102
Muranga - 10200
Musanda - 50125
Mutha - 90211
Muthaara - 60605
Muthetheni - 90113
Mutituni - 90117
Mutomo - 90201
Mutumbu - 40628
Mwala - 90102
Mwatate - 80305
Mweiga - 10104
Mwingi - 90400
Myanga - 50226
Nairage Enkare - 20504
Nairobi Buru Buru - 00515
Nairobi City Square - 00200
Nairobi Dandora - 00516
Nairobi Eastleigh - 00610
Nairobi Embakasi - 00501
Nairobi Enterprise Road - 00500
Nairobi Gigiri - 00601
Nairobi GPO - 00100
Nairobi Jamia - 00101
Nairobi Kamiti - 00607
Nairobi Kangemi - 00625
Nairobi Karen - 00502
Nairobi Kayole - 00518
Nairobi Kenyatta Hospital - 00202
Nairobi Kenyatta National Hospital - 00202
Nairobi Kenyatta University - 00609
Nairobi Langata - 00509
Nairobi Lavington - 00603
Nairobi Lower Kabete - 00604
Nairobi Mathare Valley - 00611
Nairobi Mbagathi - 00503
Nairobi Mobil Plaza - 00620
Nairobi Muthaiga - 00619
Nairobi Ngara - 00600
Nairobi Ngong Road - 00505
Nairobi Nyayo Stadium - 00506
Nairobi Ongata Rongai - 00511
Nairobi Parklands - 00623
Nairobi Ronald Ngala - 00300
Nairobi Ruaraka - 00618
Nairobi Sarit Centre - 00606
Nairobi Tom Mboya - 00400
Nairobi Uhuru Gardens - 00517
Nairobi Uthiru - 00605
Nairobi Village Market - 00621
Nairobi Wangige - 00614
Nairobi Westlands - 00800
Nairobi Yaya Towers - 00508
Naitiri - 50211
Naivasha - 20117
Nakuru - 20100
Namanga - 00207
Nambacha - 50127
Nambale - 50409
Nandi Hills - 30301
Nango - 40615
Nanyuki - 10400
Naro Moru - 10105
Narok - 20500
Ndalani - 90118
Ndalu - 50212
Ndanai - 20404
Ndaragwa - 20306
Nderu - 00229
Ndhiwa - 40302
Ndithini - 01016
Ndooa - 90202
Ndori - 40602
Ndunyu Njeru - 20317
Ng'ambwa - 80311
Ngecha - 00218
Ngewa - 00901
Nginyang - 30404
Ngiya - 40603
Ngong Hills - 00208
Nguni - 90407
Ngwata - 90129
Njoro - 20107
Nkondi - 60214
Nkubu - 60202
North Kinangop - 20318
Nunguni - 90130
Nyabondo - 40124
Nyahururu - 20300
Nyali - 80118
Nyamache - 40203
Nyamarambe - 40206
Nyambunwa - 40205
Nyamira - 40500
Nyamonye - 40632
Nyandiwa - 40333
Nyangande - 40126
Nyangori - 40127
Nyangusu - 40218
Nyangweso - 40311
Nyansiongo - 40502
Nyaramba - 40514
Nyatike - 40402
Nyeri - 10100
Nyilima - 40611
Nzeeka - 90136
Nziu - 90143
Ogembo - 40204
Ogongo - 40323
Okia - 90301
Olenguruone - 20152
Oljoroorok - 20302
Olkalou - 20303
Ololulunga - 20503
Omogonchoro - 40221
Ortum - 30602
Othaya - 10106
Oyugis - 40222
Paponditi - 40111
Pawakuche - 40131
Port Victoria - 50410
Rabuor - 40132
Ragengni - 40604
Ranen - 40412
Rangwe - 40303
Rapogi - 40403
Ratta - 40137
Reru - 40133
Rhamu - 70302
Rigoma - 40511
Riochanda - 40512
Riosiri - 40220
Rodi Kopany - 40326
Rongai - 20108
Rongo - 40404
Roret - 20204
Ruai - 00520
Ruiru - 00232
Rumuruti - 20321
Runyenjes - 60103
Rurii - 20313
Ruringu - 10133
Saba Saba - 10208
Sagalla - 80308
Sagana - 10230
Samburu - 80120
Sare - 40405
Sawagongo - 40612
Sega - 40614
Serem - 50308
Seretunin - 30407
Shianda - 50106
Shimba Hills - 80407
Shimoni - 80409
Shinyalu - 50107
Siakago - 60104
Siaya - 40600
Sidindi - 40605
Sigomre - 40635
Sigor - 20405
Silibwet - 20422
Sindo - 40308
Siongiroi - 20423
Sirisia - 50208
Sirwa - 000
Sondu - 40109
Songhor - 40110
Sosiot - 20205
Sotik - 20406
South Kinangop - 20319
Soy - 30105
Subukia - 20109
Suguta Maramar - 20602
Sulmac - 20151
Sultan Hamud - 90132
Suna - 40400
Tabaka - 40229
Takaba - 000
Tala - 90131
Tambach - 30704
Tausa - 80309
Taveta - 80302
Tawa - 90133
Tenges - 30405
Thika - 01000
Timau - 10402
Timber Mill - 20110
Timboroa - 30108
Tiriki - 50309
Tongaren - 30218
Tot - 30707
Tulia - 90203
Tunyai - 60213
Turbo - 30106
Ukunda - 80400
Ukwala - 40607
Ungunja - 40606
Uplands - 00222
Uranga - 40608
Uriri - 40228
Usenge - 40609
Vihiga - 50310
Vipingo - 80119
Viwandani - 00507
Voi - 80300
Wachoro - 60121
Wajir - 70200
Wamba - 20603
Wamunyu - 90103
Wanguru - 10303
Wanjohi - 20305
Watamu - 80202
Webuye - 50205
Weiwei - 30603
Werugha - 80303
Winam - 40141
Witu - 80504
Wodanga - 50311
Wundanyi - 80304
Yala - 40610
Yoani - 90134
Ziwa - 30214
Zombe - 90213
Mobile Number (s):
*
Branches At:
Email Address:
*
3.
Principal Officer Details
Principal Full Names
*
Nationality
*
ID or Passport No.
*
Kenya
Tanzania
Uganda
Burundi
Rwanda
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Ascension Island
Australia
Austria
Bahamas
Azerbaijan
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brit Indian Ocean Terr
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Camaroon
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fed States Micronesia
Fiji
Finland
Fmr Yugoslavia
France
French Guiana
French Polynesia
Gabon
Georgia
Germany
Ghana
Gibralter
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Saint Lucia
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
Spain
Sri Lanka
St Vincent and Grenadines
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Thailand
The Gambia
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks/Caicos Islands
Tuvalu
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands (U.K.)
Virgin Islands (U.S.)
Wallis/Futuna Islands
Western Samoa
Yemen
Zambia
Zimbabwe
United States of America
United Kingdom, Britain
Year of Birth
Academic Qualifications
Professional Qualifications
(attach Certificate)
Insurance Experience
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
4.
Ownership Details
(
Individual, Partners or Shareholders
)
-- Click 'Save to Add >> ' button to save the individual, partner or shareholder details.
Full Names
*
Nationality
ID or Passport No.
*
Soft Copy
of ID or Passport No.
Delete
Kenya
Tanzania
Uganda
Burundi
Rwanda
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Ascension Island
Australia
Austria
Bahamas
Azerbaijan
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brit Indian Ocean Terr
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Camaroon
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fed States Micronesia
Fiji
Finland
Fmr Yugoslavia
France
French Guiana
French Polynesia
Gabon
Georgia
Germany
Ghana
Gibralter
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritius
Mayotte
Mexico
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Saint Lucia
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
Spain
Sri Lanka
St Vincent and Grenadines
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Thailand
The Gambia
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks/Caicos Islands
Tuvalu
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands (U.K.)
Virgin Islands (U.S.)
Wallis/Futuna Islands
Western Samoa
Yemen
Zambia
Zimbabwe
United States of America
United Kingdom, Britain
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