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  • NHIF Employers Application Form

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    Muji Gill
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    The document is an application for employers registration with the National Hospital Insurance Fund of Kenya. It requests information from employers such as company name, address, phone number, and email as well as registration numbers and PIN to register the employer and their employees with the NHIF. Employers must fill out the form in triplicate and provide documentation like copies of registration certificates and PIN numbers to complete the registration process.

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    NHIF employers application form

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    The document is an application for employers registration with the National Hospital Insurance Fund of Kenya. It requests information from employers such as company name, address, phone number, and email as well as registration numbers and PIN to register the employer and their employees with the NHIF. Employers must fill out the form in triplicate and provide documentation like copies of registration certificates and PIN numbers to complete the registration process.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    27 views1 page

    NHIF Employers Application Form

    Uploaded by

    Muji Gill
    The document is an application for employers registration with the National Hospital Insurance Fund of Kenya. It requests information from employers such as company name, address, phone number, and email as well as registration numbers and PIN to register the employer and their employees with the NHIF. Employers must fill out the form in triplicate and provide documentation like copies of registration certificates and PIN numbers to complete the registration process.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 1

    NHIF 33

    NATIONAL HOSPITAL INSURANCE FUND


    P.O. Box 30443, NAIROBI
    Website: www.nhif.or.ke Email: info@nhif.or.ke
    To be completed in triplicate

    APPLICATION FOR EMPLOYERS REGISTRATION


    EMPLOYER'S/ORGANIZED GROUP/SPONSORS CODE ....................................................................

    Tick where applicable Employed Organised groups Sponsored

    1. Employer’s/ Organized Group/ Sponsor Particulars


    (a) Name: ..............................................................................................................................................................
    (b) Postal Address: ................................................................. Code: ...................................................................
    (c) Telephone Number:.........................................................................................................................................
    (d) E-mail Address: ...............................................................................................................................................

    2. Headquarters’ Registered Office


    (a) Business Location/Branch: ..............................................................................................................................
    (b) Road/Street: ....................................................................................................................................................
    (c) Building: ............................................................................. Floor/Room No.:...................................................

    3. Certificate/Registration Number (Attach copy)*: ....................................................................................................

    4. Company PIN Number (Attach copy):....................................................................................................................

    ...................................................................... .............................................................................
    Full Name of Authorized Officer Employer’s/Organized Group Official Stamp

    ...................................................................... .............................................................................
    Signature Date

    FOR OFFICIAL USE ONLY


    1. Received By: Approved and Issued Code By:
    (a) Full Name _____________________________ (a) Full Name ______________________________
    (b) Signature ______________________________ (b) Signature _______________________________
    (c) Date __________________________________ (c) Date __________________________________

    2. Inspected and Recommended By:


    (a) Full Name _____________________________
    (b) Signature ______________________________
    (c) Date __________________________________

    NB: The following other documents are also valid


    • Copy of Kenya Gazette
    • Copy of the Act of parliament

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