Fillable Online Disclosure Statement of Potential Conflict 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Membership Number, KRA PIN, and personal details such as Surname, Middle Name, and Gender. Ensure all entries are in capital letters for clarity.
3. Fill in your Date of Birth, Marital Status, Nationality, and contact information including Email Address and Mobile Phone Number.
4. Provide your Physical Residence and Postal Address along with the Postal Code and Town. Include your Branch and Account Number.
5. Complete the Employment Details section if you are a salaried applicant. If self-employed, fill out the Business Details section with relevant information about your business.
6. List your Next of Kin details for emergency contact purposes. Include their Full Names, ID Number, Email Address, Relationship, and Telephone Number.
7. Designate a Nominee by providing their Full Names, ID Number (or indicate 'minor'), Email Address, Relationship, Telephone Number, and % Allocation.
8. Finally, review the Declaration section. Sign and date the form to confirm that all provided information is accurate. Ensure witnesses sign as required.

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