HELB Application – Kibtech Online Cyber

Full name *

ID Number/Birth Certficate *

Per Division Mother

KRA Number *

Phone Number *

Date of Birth *

Gender *

Marital Status *

Are you a person with a disability? *

P.O Box Number *

Postal Code/Number *

Town

County of Birth *

Constituency *

Ward *

Division *

Location *

Sub-Location *

Village *

Secondary Name *

KCSE Index Number *

KCSE Year *

Are you placed by KUCCPS?

Are you sponsered in secondary?

Primary Name *

KCPE Index Number *

KCPE Year *

Are you sponsered in primary school? *

Name of your Campus (University/KMTC/TVET) *

ADM/Registration Numer *

Your Course *

Year of your Admission *

Total Fees Per Year *

Which type of family do you come from? *

Fill the details of the parent who is not deceased (Name, ID number and Phone number)

Father's Name

Father ID Number

Must Be register using his ID details

Father Phone Number

Must Be register using his ID details

Mother's Name

Mother ID Number

Must Be register using her ID details

Mother Phone Number

Must Be register using her ID details

Quarantor 1: Full Name *

Quarantor 1: ID Number *

Must Be register using his/her ID details

Quarantor 1: Phone Number *

Must Be register using her ID details

Quarantor 2: Full Name *

Quarantor 2: ID Number *

Must Be register using her ID details

Quarantor 2: Phone Number *

Must Be register using his/her ID details (Either safaricom/Airtel)

Mode Of Payment, Which Payment account do you have? *

Bank
Mpesa

Your MPESA Number/Bank Account Number *

Bank Name (If you have a bank account)

Bank Branch (If you have a bank account)

e.g Kitale Town