Individual Information

Title:

TIN:

*Surname:

*Firstname:

Middle Name:

Acquired Name:

*Sex:

*Date of Birth:

*Completing on behalf of minor?:

Yes No

*Mother's Maiden Name:

Contact Address

Box Number:

*District:

*Mobile Number:

Second Mobile Number:

Landline Number:

*Email:

Address in Uganda

Plot Number:

Street Name:

Building Name:

*Trading Center:

*District:

*County:

*Sub County:

*Parish:

*Village:

Section B – Four to Five Star Filing

*Country of Citizenship:

Identification Documents(supply minimum of 2)

Passport Number:

National Identification Card :

NSSF Number:

Financial Card:

Driving Permit:

Work Identity Card:

Diplomatic ID:

Employee's ID Number:

Voter's Card Number:

Village Identification Card :

COIN Registration Reason

*Why do you need a COIN?: