Agents & Stock Application Form – Kenya Seed Company Limited

DISCLAIMER: These applications are NOT a confirmation of allocation.One has to start as a stockist before they are upgraded to an agent.

First Name of Applicant

Second Name of Applicant

District

Market

Telephone

Postal Address

Your Email

Date of Application

Date of Assessment:

Remarks

Please tick the checkbox if remarks approved of not approved:
ApprovedNot Approved

Name of Assessing Officer

Designation

Has the applicant paid Kephis license fee?
PaidNot Paid

Receipt Number

Stocklist Card Number