Account Opening Request (AOR) Form

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Name

Phone Number

Are you a healthcare professional?

Business Name

Business Email

Business Phone Number

Certificate by the Registrar of Kenya, Attach a File: (Please upload a file up to 2MB)

Drag and drop files here or

Max File Size: 2 MB

Annual License by the PPB, Attach a File: (Please upload a file up to 2MB)

Drag and drop files here or

Max File Size: 2 MB

PIN Certificate by KRA, Attach a File: (Please upload a file up to 2MB)

Drag and drop files here or

Max File Size: 2 MB

I confirm that the details I have provided are correct.

Confirm

By clicking the "Submit" button, you confirm your consent to the processing of the personal data as provided in the request form. Wega Healthcare Ltd and its affiliates solely to provide a response to your request will use personal data.