Individual Registration

Bio Data

First Name*

First Name

Middle name

Middle Name

Last Name*

Last Name

Date of Birth*

Date of Birth ×

Phone Number*

Phone

Gender*

Contact Email Address*

Contact Email Address

ID Number*

ID Number

Upload ID

Max file size: 9.54 MB. | Allowed file types: | Max number of files: 2 | Min number of file: 1

Take a photo of the ID

Location Details

County*

County

Sub County*

Ward*

Community Unit*

Area of residence (Village)*

Your area of residence

Informal Sector*

Write here

Health Plan

Have health plan

No Yes

If Yes, Select your preferred plan

MARWA PLUS

NHIF

Others

Write here

Is Health Plan Active

No Yes

Have dependent*

Dependent 1

Dependent type*

Child

Spouse

Others

Write here

First Name*

First Name

Middle Name*

Middle Name

Last Name*

Last Name

Gender*

Date of Birth*

Date of Birth ×

Relationship Document Type*

Write here

ID Number*

ID Number

Spouse ID and Marriage Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Child ID and Birth Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Proof of Relationship

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

Select Files

Add another dependent*

Yes

Dependent 2

Dependent type*

Child

Spouse

Others

Write here

First Name*

First Name

Middle Name*

Middle Name

Last Name*

Last Name

Sex*

Date of Birth*

Date of Birth ×

Checkbox Options Title*

Marriage Certificate

Birth Certificate

Chief’s Letter

Others

Write here

ID Number*

ID Number

Spouse ID and Marriage Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Child ID and Birth Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Proof of Relationship

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

Select Files

Add another dependent*

Yes

Dependent 3

Dependent type*

Child

Spouse

First Name*

First Name

Middle Name*

Middle Name

Last Name*

Last Name

Sex*

Date of Birth*

Date of Birth ×

Checkbox Options Title*

Marriage Certificate

Birth Certificate

Chief’s Letter

Others

Write here

ID Number*

ID Number

Spouse ID and Marriage Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Child ID and Birth Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Proof of Relationship

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

Select Files

Add another dependent*

Yes

Dependent 4

Dependent type*

Child

Spouse

First Name*

First Name

Middle Name*

Middle Name

Last Name*

Last Name

Sex*

Date of Birth*

Date of Birth ×

Checkbox Options Title*

Marriage Certificate

Birth Certificate

Chief’s Letter

Others

Write here

ID Number*

ID Number

Spouse ID and Marriage Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Child ID and Birth Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Proof of Relationship

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

Select Files

Add another dependent*

Yes

Dependent 5

Dependent type*

Child

Spouse

First Name*

First Name

Middle Name*

Middle Name

Last Name*

Last Name

Sex*

Date of Birth*

Date of Birth ×

Checkbox Options Title*

Marriage Certificate

Birth Certificate

Chief’s Letter

Others

Write here

ID Number*

ID Number

Spouse ID and Marriage Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Child ID and Birth Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Proof of Relationship

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

Select Files

Add another dependent*

Yes

Dependent 6

Dependent type*

Child

Spouse

First Name*

First Name

Middle Name*

Middle Name

Last Name*

Last Name

Sex*

Date of Birth*

Date of Birth ×

Checkbox Options Title*

Marriage Certificate

Birth Certificate

Chief’s Letter

Others

Write here

ID Number*

ID Number

Spouse ID and Marriage Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Child ID and Birth Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Proof of Relationship

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

Select Files

Add another dependent*

Yes

Dependent 7

Dependent type*

Child

Spouse

First Name*

First Name

Middle Name*

Middle Name

Last Name*

Last Name

Sex*

Date of Birth*

Date of Birth ×

Checkbox Options Title*

Marriage Certificate

Birth Certificate

Chief’s Letter

Others

Write here

ID Number*

ID Number

Spouse ID and Marriage Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Child ID and Birth Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Proof of Relationship

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

Select Files

Add another dependent*

Yes

Dependent 8

Dependent type*

Child

Spouse

First Name*

First Name

Middle Name*

Middle Name

Last Name*

Last Name

Sex*

Date of Birth*

Date of Birth ×

Checkbox Options Title*

Marriage Certificate

Birth Certificate

Chief’s Letter

Others

Write here

ID Number*

ID Number

Spouse ID and Marriage Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Child ID and Birth Certificate (Optional)

Max file size: 9.54 MB. | Allowed file types: jpeg,png,jpg,pdf

Select Files

Proof of Relationship

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

Select Files

Register as individual

Bio Data

Upload ID

Location Details

Health Plan

Dependent 1

Spouse ID and Marriage Certificate (Optional)

Child ID and Birth Certificate (Optional)

Proof of Relationship

Dependent 2

Spouse ID and Marriage Certificate (Optional)

Child ID and Birth Certificate (Optional)

Proof of Relationship

Dependent 3

Spouse ID and Marriage Certificate (Optional)

Child ID and Birth Certificate (Optional)

Proof of Relationship

Dependent 4

Spouse ID and Marriage Certificate (Optional)

Child ID and Birth Certificate (Optional)

Proof of Relationship

Dependent 5

Spouse ID and Marriage Certificate (Optional)

Child ID and Birth Certificate (Optional)

Proof of Relationship

Dependent 6

Spouse ID and Marriage Certificate (Optional)

Child ID and Birth Certificate (Optional)

Proof of Relationship

Dependent 7

Spouse ID and Marriage Certificate (Optional)

Child ID and Birth Certificate (Optional)

Proof of Relationship

Dependent 8

Spouse ID and Marriage Certificate (Optional)

Child ID and Birth Certificate (Optional)

Proof of Relationship

Your registration request has been submitted