Rise Her Initiative
#BeBold #BeConfident
Self Help Group Registration
Personal Information
Basic Information
Surname:
*
First Name:
*
Other Name(s):
ID Number:
*
Phone Number:
*
Email Address:
Date of Birth:
*
Gender:
*
Select Gender
Male
Female
Marital Status:
*
Occupation Details
Occupation:
Employed
Self-Employed
Name of Employer:
*
Physical Location:
*
Nature of Business:
*
Physical Location:
*
Address Details
County:
*
Sub-county:
*
Ward:
*
Physical Location (Estate, Village, Nearest Town/Shopping Centre):
*
Attachments
Attach Passport Photo
*
Choose file
Attach ID
*
Choose file
Attach KRA Certificate
Choose file
Next of Kin Details
Name:
*
Relationship:
*
Select Relationship
Spouse
Husband
Wife
Father
Mother
Sibling
Brother
Sister
Son
Daughter
Uncle
Aunt
Cousin
Nephew
Grandfather
Grandmother
Grand Child
Father-In-Law
Mother-In-Law
Brother-In-Law
Sister-In-Law
Son-In-Law
Daughter-In-Law
Guardian
Trustee
ID Number:
*
Phone Number:
*
+ Add Next of Kin
Name
Relationship
ID Number
Phone
Confirmation
I understand and agree with the
Terms & Conditions
. You will receive registration confirmation via text.
Already a member?
Login Instead
