Laravel

First Name *

Middle Name

Last Name *

Phone Number *

Email Address *

Date of Birth *

Gender *

National ID Number *

County *

Sub County

Physical Address / Landmark *

Occupation / Job Title

Business or Employer Name

Business Type / Industry

Monthly Income (KES)

Years in Business / Employment

Next of Kin Full Name

Next of Kin Phone Number

Relationship

National ID Photo (Front) *

Proof of Income (Optional)

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