Please enter the date you are filling this form (today's date)

What are your OFFICIAL names?

Please enter the date you were born (If you are using a mobile phone to fill this form, to quickly select the right date, please click the year on the top left and then select the right year, month and date)

Please select your gender

What is your ID number?

Which COUNTRY are you located in?

Which COUNTY are you located?

What is the name of your town/shopping centre/local area/village?

Approximately, what date did you start living in the location or when did you start your business in this location? (If you are using a mobile phone to fill this form, to quickly select the right date, please click the year on the top left and then select the month and date)

What is your Mobile Number?

What is your WhatsApp Number. DO NOT fill in if your WhatsAPP number is the same as Mobile number

What is your MPESA number (for payments)? Leave blank if it is the same as your Mobile Number

What is your preferred way of communication?

Are you employed by someone of self employed

What is your highest level of education

If your education level is Tertiary/college/university, please type in what you studied (leave blank if your level of education is Secondary School and below)

What is your current profession (what do you do for a living) (text) e.g. carpenter, farmer, teacher, businessman.

What is your Tax ID.

A link to your Facebook account.

A link to your Instagram account.

A link to your Linkedin account profile.

A link to your Tiktok account.

Please specify your side hustle if any.

If you do business or if you are employed in a business, what type of business is it? E.g. restaurant or MPESA or Cyber Café. Please leave the field blank if you don't run or work in a business

If you run or work in a business, what is the name of the business? E.g. Mama Toto Kiosk, or Kwetu Cyber Café or Mapocho Restaurant. Leave this field blank if you do not run or work in a business

Please describe the location of your business e.g. Next to the police station or Behind Equity Bank or Next to Mama Toto Kiosk

If you do business or if you are employed in a business, what date did the business start?