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NAMES IN FULL:

First Name

Middle Name

Last Name

Clan Name

Details:

Date of Birth

Gender

Marital Status

Occupation

NHIF Status

Blood Group

Identification:

Select Identity Type

ID Number

Passport Number

Contact Details:

Email

Phone

Password:

Password

Confirm Password

Next of Kin Details:

Name of Next of Kin

Phone of Next of Kin

Select Identity Type of Kin

ID Number of Kin

Passport Number of Kin

Location Details:

Country

County

Sub County

Location

Sub Location

City

Children Details:

Please fill in the details below if you have children. Enter the full name of the child, age, and gender.

Name of Child

Date of Birth

Gender