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Business Name*

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Business Address*

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Number of Partners*

Partner 01

Name*

Date of Birth* (mm/dd/yy)

ID/Passport No*

PIN No*

Residential Address*

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City*

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Email:*

Existing Client*YesNo

Home Ownership*TenantOwnerCo-Owner

Nature of Business/Profession*

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Partner 02

Name*

Date of Birth* (mm/dd/yy)

ID/Passport No*

PIN No*

Residential Address*

Postal Code*

City*

Telephone (O)* +254

Telephone (R) +254

Telephone (M) +254

Email*

Existing Client* YesNo

Home Ownership* TenantOwnerCo-Owner

Nature of Business/Profession*

Marital Status MarriedSingleDivorcedWidowed

Spouse Name

Spouse ID

Spouse PIN

Spouse Business/Profession

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Telephone (M) +254

Partner 03

Name

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PIN No

Residential Address

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City

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Email:

Existing Client YesNo

Home Ownership TenantOwnerCo-Owner

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Spouse PIN

Spouse Business/Profession

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Telephone (R) +254

Telephone (M) +254

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