Udhamini wa uanzishaji / Activation warranty

Nambari ya seria / Serial number

Name

Jinsia / Gender

Mwanaume / Man Mwanamke / Woman

Anwani / Address

Jina la shirika la washirika / Name of partner organization (Optional)

Nambari ya utambulisho wa wakala / ID number of the agent (Optional)

Jina la wakala / Name of the agent (Optional)

Nchi / Country

Chagua nchi / Select country ?land Islands Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi C?te d'Ivoire Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (Democratic Republic of the) Cook Islands Costa Rica Croatia Cuba Cura?ao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (Democratic People's Republic of) Korea (Republic of) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia (the former Yugoslav Republic of) Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Moldova (Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar R?union Romania Russian Federation Rwanda Saint Barth?lemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom of Great Britain and Northern Ireland United States Minor Outlying Islands United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

Wilaya ya kata / County

Mombasa Kwale Klifi Tana Lamu Taita Garissa Wajir Mandera Marsabit Isiolo Meru Tharaka Embu Kitui Machakos Makueni Nyandarua Nyeri Kirinyaga Murang'a Kiambu Turkana West Pokot Samburu Trans Nzoia Uasin Gishu Elgeyo Marakwet Nandi Baringo Laikipia Nakuru Narok Kajiado Kericho Bomet Kakamega Vihiga Bungoma Busia Siaya Kisumu Homa Bay Migori Kisii Nyamira Nairobi

Wilaya / Sub-County

Chagua wilaya / Select Sub-County

Kijiji / Village

Nambari ya simu / Phone

Nambari ya simu 2 / Phone 2 (Optional)

Nambari ya simu 3 / Phone 3 (Optional)

Barua pepe / Email

Tarehe ya ununuzi / Purchase date

Unutaka kupata habari mpaya kuhusu nazava? / Get the latest news from nazava?

Ndio / Yes Hapana / No

Hakuna cha kusahau? / Forget something

Ndio / Yes Hapana / No

Tuma / Send Safisha /Clear