Pharmacies Login

This form should only be used by pharmacies, chemists and resellers who buy in bulk. You must upload your Poisons Board certificate otherwise you will not be able to transact

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User Type *

Sales Person who Referred You (If Applicable)
Upload an image of your shop *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx
Download and fill the form
Fully Filled Credit Application Form
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx
Company / Business Name *
Download and fill the Form
Address *
Postal code *
Company Telephone Number *
Physical Location *
Contact Person 1 - First and Last Name *
Designation
Copy of ID *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx
Select your Preferred Branch *
Copy of Practicing License from Pharmacy and Poisons Board or from any other Regulatory Board *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx
Copy of Company Certificate of Incorporation/Partnership Deed/Business Registration Certificate *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx
Copy of the National Identity card or Passport for the Directors guarantying the Company *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx
Copy of Memorandum and Articles of Association (Page showing the shareholding) or copy of CR12 *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx
Copy of KRA PIN certificate *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx
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