CYBER REGISTRATION FORM

BIGGEST CYBER STATION NETWORK IN KENYA

RECEIVING DATE*

RECEIVING DATE

Receiver Name*

Receiver Position*

Receiver Code*

Agent Name*

Agent Passport Size Photo*

Agent ID Number*

ID COPY*

Agent Mobile Number*

Agent E-mail*

workers' delivery monthly*

from which Office/Agent*

Are you registered Agent

No
Yes

Agent certificate copy

Agent Physical Address*

Agent Postal Address*

Agent Residential Address*

Agent Undertaking Letter

File Upload*

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