School Form Creditstar Microinsurance

SCHOOL KYC FORM

09087966325 or email info@mycreditstar.com

School Name:

School Address:

Branch 1 Address:

Branch 2 Address:

School Type:

Ownership Structure

Incorporation/Approval Certificate No:

Incorporation/Approval Date:

Email:

URL (website):

Number of Students last school year:

School Phone No:

State number of casualties in the last Academic year:

Do you have a school clinic?:

Do you include medical fees in the school fee?:

When is your next PTA meeting?:

Do you have school buses?:

Please list details of the School’s Senior Management including the Proprietor/Principal/Administrator etc:

FullName :

Nationality:

Position/Function :

Tel No:

Regulatory License issued by the Regulator
Copies of Current Constitutional Documentation:

Certificate of Incorporation.

Evidence of Approval.

Authorized Person’s valid form of identification (Y/N):

I hereby confirm to the best of our knowledge and belief that the information contained in this questionnaire and any attachment hereto is correct.

Name:

Position in the school:

Date: