My account

Login

Register

Email address Required

A link to set a new password will be sent to your email address.

Phone

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

Company / Business Name *

Fully Filled Credit Application Form
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx

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

Back to login