Blank HELB form
Serial No# : 1637862
Last Name
First Name
Middle Name
ID/No. (attach copy)
Pin No. (attach copy)
Date of birth(DD/MM/YYYY)
©EasyCyber Café-Eldoret Safina Plaza Next to Mt.Kenya University
Email
Physically Challenged?
Telephone
Fax No.
Box Number
County Code
Sub-location
Location
Division
Marital Status
Town/City
Nearest Public Primary
Estate/Village
Sub-location
Location
County Code
Constituency name
Division
Country
University Name
Campus code
Faculty/School
Year of admission
Admission Category
Registration/Admission Number( as indicated on your admission letter)
Amount Applied For ?
Kshs.
Amount your family can raise towards your fees ?
Kshs.
Do you require bursary ?
National ID No.
Current year of study
Names
Gender
Attach certified copies of your certificates
Level
PRIMARY
Institution Name
Exam Yr
Index Nunber
School Type
Country Code
SECONDARY
Note: for salary/pension income attach copy of payslip
Last Name
First Name
Middle Name
I
ID/No. (attach copy)
Year of birth
Highest Level of education
Gross Salary(Monthly)
Pin No. (attach copy)
Mobile/Wireless Telephone
Employed
Business (Annual)
no.
Farming (Annual)
Occupation/Profession
Employer telephone no.
Pension(Monthly)
©EasyCyber Café-Eldoret Safina Plaza Next to Mt.Kenya University
Name of employer/business or former employer if no longer employed (attach evidence if no
longer working)
Income from ‘other’ e.g.
Support from GoK relief service
Last Name
First Name
Middle Name
ID/No. (attach copy)
Year of birth
Highest Level of education
Gross Salary(Monthly)
Pin No. (attach copy)
Mobile/Wireless Telephone
Employed
Business (Annual)
no.
Farming (Annual)
Occupation/Profession
Employer telephone no.
Pension(Monthly)
Name of employer/business or former employer if
Last Name
First Name
Middle Name
ID/No. (attach copy)
Pin No. (attach copy)
Date of birth(DD/MM/YYYY)
©EasyCyber Café-Eldoret Safina Plaza Next to Mt.Kenya University
Physically Challenged?
Telephone
Fax No.
Box Number
County Code
Sub-location
Location
Division
Marital Status
Town/City
Nearest Public Primary
Estate/Village
Sub-location
Location
County Code
Constituency name
Division
Country
University Name
Campus code
Faculty/School
Year of admission
Admission Category
Registration/Admission Number( as indicated on your admission letter)
Amount Applied For ?
Kshs.
Amount your family can raise towards your fees ?
Kshs.
Do you require bursary ?
National ID No.
Current year of study
Names
Gender
Attach certified copies of your certificates
Level
PRIMARY
Institution Name
Exam Yr
Index Nunber
School Type
Country Code
SECONDARY
Note: for salary/pension income attach copy of payslip
Last Name
First Name
Middle Name
I
ID/No. (attach copy)
Year of birth
Highest Level of education
Gross Salary(Monthly)
Pin No. (attach copy)
Mobile/Wireless Telephone
Employed
Business (Annual)
no.
Farming (Annual)
Occupation/Profession
Employer telephone no.
Pension(Monthly)
©EasyCyber Café-Eldoret Safina Plaza Next to Mt.Kenya University
Name of employer/business or former employer if no longer employed (attach evidence if no
longer working)
Income from ‘other’ e.g.
Support from GoK relief service
Last Name
First Name
Middle Name
ID/No. (attach copy)
Year of birth
Highest Level of education
Gross Salary(Monthly)
Pin No. (attach copy)
Mobile/Wireless Telephone
Employed
Business (Annual)
no.
Farming (Annual)
Occupation/Profession
Employer telephone no.
Pension(Monthly)
Name of employer/business or former employer if