LUTAN TECH
HELB Application Details Form
Personal Details
Location & Contact Details
* Highly recommend sending directly via WhatsApp
* PDF format only. Feature under development. Recommend sending manually via WhatsApp (0711 808286).
Kindly note: This page requires you to enter the address for the location of the institution, NOT your home address.
Secondary School Details
Primary School Details
Higher Institution Details
If 'Yes' you are Government Sponsored. If 'No' you are Self Sponsored.
Government Sponsored Details
Self Sponsored Details
* Fill these details for the university/college or TVET you are reporting to.
Family Details
FATHER'S DETAILS
MOTHER'S DETAILS
FATHER'S DETAILS
MOTHER'S DETAILS
Guarantors' Details
Must be filled twice for Guarantor 1 and Guarantor 2.
Guarantor 1
Guarantor 2
Payment Details
Verify carefully. We are NOT liable for typos in mobile/bank account numbers.
Final Summary Preview
Personal Details
Name: "null"
Gender: "null"
Physically disabled: "null"
Marital Status: "null"
Employment Status: "null"
Education Level: "null"
Date of Birth: "null"
Email: "null"
Any Other Info: "null"
Location Details
P.O. Box: "null"
Postal Code: "null"
Town: "null"
County: "null"
Constituency: "null"
Ward: "null"
Division: "null"
Location: "null"
Sub-Location: "null"
Home Address: "null"
Village: "null"
Nearest Primary School: "null"
Nearest street/Road: "null"
Nearest Town: "null"
Education Details
Secondary School Name: "null"
Sec Sch. county: "null"
Sec School Division: "null"
Sec Sch. Location: "null"
Sec Sch. Sub-Location: "null"
Sponsored: "null"
Exam Type: "null"
KCSE year: "null"
KCSE index Number: "null"
Primary School Name: "null"
Pri Sch. county: "null"
pri School Division: "null"
pri Sch. Location: "null"
pri Sch. Sub-Location: "null"
Exam Type: "null"
KCPE year: "null"
KCPE index Number: "null"
Govt Sponsored Institution
Mode of study: "null"
Registration No.: "null"
Year of Admission: "null"
Current year of study: "null"
Self Sponsored Institution
Institution: "null"
County: "null"
Level of study: "null"
Type of Course: "null"
Course: "null"
Year of Admission: "null"
Year of Completion: "null"
Annual Cost of Programme: "null"
Duration: "null"
Mode of Study: "null"
Current Year of Study: "null"
Reg no: "null"
Mother's Details
First Name: "null"
Type of Id: "null"
Id No: "null"
Mobile service provider: "null"
Mother's Phone number: "null"
KRA pin: "null"
Father's Details
First Name: "null"
Type of Id: "null"
Id No: "null"
Employed: "null"
Mobile service provider: "null"
Father's Phone number: "null"
KRA pin: "null"
Mother's Details
First Name: "null"
Type of Id: "null"
Id No: "null"
Employed: "null"
Mobile service provider: "null"
Mother's Phone number: "null"
KRA pin: "null"
Father's Details
First Name: "null"
Type of Id: "null"
Id No: "null"
Employed: "null"
Mobile service provider: "null"
Father's Phone number: "null"
KRA pin: "null"
Guarantor 1
First Name: "null"
Id No: "null"
Phone No: "null"
Employed: "null"
KRA PIN: "null"
County: "null"
Division: "null"
Location: "null"
Guarantor 2
First Name: "null"
Id No: "null"
Phone No: "null"
Employed: "null"
KRA PIN: "null"
County: "null"
Division: "null"
Location: "null"
Mode of Payment
Mode: "null"
Mobile No: "null"
Account No: "null"
