RuralPoint

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REGISTRATION FORM

Your bridge to success

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PERSONAL INFORMATION

DATE OF REGISTRATION

Full Name *

Nickname

Date of Birth *

Phone Number *

Gender *

Marital Status *

Single Married Divorced Widowed

Country *

National ID No. *

Place of Birth

Nationality *

Domicile

CP Domicile

Start Time

Post Code

RURAL ADDRESS

Present Address *

The City *

Postal Code

Present County *

Physical Location

RURAL INFORMATION

Rural Enterprise Name *

Rural Enterprise Type *

Business Address

CAPITAL INVESTED

What amount of capital has been/will be invested?

Please state source of funds

EXPECTED TURNOVER

What is the business' weekly or monthly turnover likely to be?

DOCUMENT UPLOADS

National ID Document *

Upload front and back of ID (PDF, JPG, PNG)

Selfie Photo *

Upload a clear selfie photo (JPG, PNG)

Utility Bill

Upload recent utility bill (PDF, JPG, PNG)

Bank Statement

Upload recent bank statement (PDF, JPG, PNG)

Logbook

Upload vehicle logbook (PDF, JPG, PNG)

Title Deed

Upload title deed (PDF, JPG, PNG)

SIGNATURE

Digital Signature

Upload your signature image (JPG, PNG)

DECLARATION

I/We confirm that:

A) The information we have provided herein and the disclosure made are true
B) We have received, read, and understood the general terms and conditions of RuralPoint Kenya Limited and undertake to comply, observe, and be bound by the same.

Full Names as per ID/PP *

Personal P.I.N

RECOMMENDERS

Recommender Name

Recommender ID/PP No.

Recommender Tel

Recommender Mobile

Current Place of Residence

GUARANTORS (Optional)

Guarantor Name

Guarantor ID/PP No.

Guarantor Tel

Guarantor Mobile

Current Place of Residence

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