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INTERN'S BIO DATA

PERSONAL/DEMOGRAPHIC DETAILS
Salutation: Mr Surname: KIGEN First Name: MALON
Other Names KIPKOECH Gender: M
Date of Birth: 27-12-1996 Birth Cert. Entry No. 861518 Nationality: Kenya
Ethnicity: Kalenjin Marital Single
Status:
ID/No: 33598510 (Attach copy) KRA PIN: A009415661A
NHIF Card No: 9773564 NSSF No: 203308426X
Are you a 3333 Disability: N Impairment: -
person living
with disability?
CONTACT & PHYSICAL ADDRESS
Address: 1404 Code: 20100 Town: NAKURU
Mobile Number: 0792274729 Email: malonkipkoechkigen@gmail.com
Names of next of Betty Maiga Relationship Sibling
kin: to next of
kin:
Next of kin 0707732482
Mobile number:
Home County Nakuru Home Njoro
Constituency
:
Home Ward: Mauche Home
Location:
ACADEMIC DETAILS
Area of Study: Mathematics, Actuarial Science Area of Economics & Statistics
& Economics Specilization
:
Academic Level: Degree

Declaration:
I hereby certify to the best of my knowledge that the particulars given on this form are correct and I
understand that it is binding.

Intern¶s ____________________ Date: ______________


Signature:
Data input Verified by:
Name: ____________________ Signature: ________________
Date: ___________________

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