01
Personal Details
02
Home Details
03
Premium Payment
Personal Details
First name
Last name
Date of Birth
Day of Birth
Month of Birth
January
February
March
April
May
June
July
August
September
October
November
December
Year of Birth
ID Number
KRA Pin
Mobile Number
+254
Email Address
Next of Kin Full name
Next of Kin Phone Number
+254
Next of Kin Email Address
Optional
Next of Kin ID Number
Agent ID
Optional
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