CADIF

A. Enter your personal details
Type of holder:	Individual Corporate
Title:
First name:
Family name:
Date of birth:
Corporate name:
Address:



Country:
Telephone:
E-mail:
Occupation:

B. Investment shares required
Select the investment level:
Select currency:
Area of investment:
State Special Investment request from CadifKenya
Enter the investment amount

C. Declaration and signature(s) I / We declare, that: We make this application in accordance with the terms in the prospectus and the Terms and Conditions below. I / We have attained 18 years of age and above.
	Please tick if you are or if you intend to be resident Kenya for the purposes of liability to Kenya income tax.
	Please tick if you are already an investor in Kenya
The application forms an integral part of CadifKenya Investment promotion and other authorized documents on the terms of which alone applications will be considered. Please enter the date that the paper copy of the application form will be signed.
Date:

D. Enter the Advisor details
Your investment advisor
Title:
First name:
Family name:
Firm:
Address:



Country:
Telephone:
E-mail:
Your ref. for this application:

CadifKenya

P.O.BOX 9104(40140)

KISUMU-KENYA