The automobile association of kenya



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THE AUTOMOBILE ASSOCIATION OF KENYA

P O BOX 40087 – 00100 NAIROBI

Tel: 020-2636792, 0722205106, 0733620966

Website: aakenya.co.ke

Kindly Update your Information below to help us serve you better;

(COMPLETE IN BLOCK CAPITALS)


SURNAME







OTHER NAMES







First Name Middle Name

NATIONALITY





GENDER(Please tick)





MALE




FEMALE

ID/PASSPORT NO.





































DATE OF BIRTH




D


D


M


M


Y


Y


Y


Y

PROFESSION/ OCCUPATION



POSTAL ADDRESS





POSTAL CODE





TOWN




PHYSICAL ADDRESS

(Street & Estate)




VEHICLE REG. NO.






NORMAL USE OF VEHICLE (Please tick)



PRIVATE




COMMERCIAL


TELEPHONE NO.




CELL PHONE NO.




E-MAIL ADDRESS












HAVE YOU BEEN A MEMBER OF AA BEFORE? (Please tick)



YES




NO


QUOTE MEMBERSHIP NUMBER







SOCIAL MEDIA PREFFERED (Please tick)






















I ______________________________(Name) hereby certify that the details given above are correct.

SIGNATURE





DATE



D


D


M


M


Y


Y


Y


Y



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