Serial No:...........................................

SUBSCRIBER REGISTRATION FORM

SUBSCRIBER TELEPHONE NUMBER:........................................................................................................
FIRST NAME.................................................................................................. MIDDLE NAME................................................................. LAST NAME............................................................................
(Full names as they appear on Identification document)
DATE OF BIRTH: DD............................/MM.........................../ YY..........................................

GENDER: MALE

FEMALE

NATIONALITY:................................................................................................................................................. OTHERS (SPECIFY COUNTRY):......................................................................................................

TYPE OF IDENTIFICATION: National ID

Passport Alien ID Military ID Birth Certificate Certificate of Registration/incorporation

IDENTIFICATION NUMBER:....................................................................................................................
POSTAL ADDRESS: (where available): P.O BOX............................................................... POSTAL CODE:.............................. TOWN/CITY:............................................................................
PHYSICAL ADDRESS: ESTATE / VILLAGE.............................................. HOUSE NO/PLOT NO........................ ROAD.......................... WARD................. COUNTY..........................
ALTERNATE CONTACT TELEPHONE NUMBER: 1: ........................................................................................................ 2: ....................................................................................................................

AIRTEL MONEY REGISTRATION

By completing this section, I hereby acknowledge that I shall be registered for Airtel Money services. I understand that I may opt out of the services at any
time by giving written notification to Airtel. I acknowledge that my use of Airtel Money services is subject to Airtel Money Customer Terms and Conditions.
I acknowledge that the Airtel Money Terms and Conditions constitute a binding agreement between me and Airtel Networks Kenya Limited .
Customers Signature...................................................................................................................................
NEXT OF KIN DETAILS: FULL NAMES...................................................................................... RELATION.................................. CONTACT NO:..........................................................................

REGISTRATION OF A MINOR

(Persons Under 18 years to register in the presence of a Guardian)

MINORS FIRST NAME........................................................................................ MIDDLE NAME.......................................................................... LAST NAME .....................................................................................
(Full names as they appear on Birth Certificate)
MINORS DATE OF BIRTH: DD......................../MM....................../ YY...........................
MINORS GENDER: MALE

FEMALE

MINORS BIRTH CERTIFICATE NUMBER ......................................................................................

GUARDIANS FIRST NAME............................................................................. MIDDLE NAME.......................................................................... LAST NAME .....................................................................................

(Full names as they appear on Identification Document)
GUARDIANS GENDER: MALE

FEMALE

GUARDIANS IDENTIFICATION NUMBER................................................................................................

Seen customer in person

Dealer / Agent Name:.....................................................................................................
Customer signed subscriber registration form (Airtel Money Registration)
Dealer / Agent Outlet: ...................................................................................................
Proof of ID matched to the customer registering
Dealer / Agent Assistant Name: ..............................................................................
Clear copy of National ID/ Passport/ Alien/ Birth Certificate/Military ID attached Dealer / Agent Assistant ID / Passport No: ........................................................
Certificate of Registration/Certificate of Incorporation/Directors ID (For Company Registration)
AGENTS DECLARATION
I (Agents name) ............................................................................................................................................................................. of postal address......................................................................................
being duly appointed and authorized as an Agent of Airtel Networks Kenya Limited, confirm that I have Inspected the identification documents presented by
.................................................................................................................................................................................... (subscribers name) appearing in person before me for registration of
SIM - card Number ............................................................ and verified to the best of my knowledge, that the identification document is representative of the said person.
I also confirm that I have entered the correct information as per the documents provided to me. I have further taken copies of all relevant documents presented
to me for the registration of the stated SIM - card and annexed the documents to this Form.
Agents Full Name............................................................................................................................................. Agents National Identification Card Number........................................................
Dated:..............................................., 20............

TERMS & CONDITIONS AIRTEL MONEY

1. This Agreement contains the complete terms and conditions that apply to your participation in Airtels Mobile Money Transfer Service and superse des
all other agreements entered into between you and Airtel Networks Kenya Limited of P.O. Box 73146 00200, Nairobi, with respect to Airtel Money mobile
money services. These terms and conditions take effect on the date of publication. By participating in or continuing to use Airtel Money service you shall
be deemed to be making an affirmative statement of your acceptance of these terms and conditions.
2. You will be able to use your account to perform transactions using the electronic mobile money wallet (Wallet Transactions) and transactions using the
card (Card Transactions) where applicable. You can use the USSD menu from your mobile device to perform the following Wallet Transactions:
3. 3.1

Buying value-added services made available on the USSD menu (such as prepaid airtime and prepaid electricity)

3.2

Sending cash to other users of any cellphone number on any mobile network in Kenya.

3.3

Deposit money into own account from agents or top up from a bank account

3.4

Customers can only deposit money into their own account.

3.5

A withdrawal fee may be charged to the customer.

3.6

Unlimited number of recharges can be made per day. Limits will apply as per regulations that exist and in force from time to time.

3.7

Maximum balance according to Airtel Money limits will apply.

3.8

No refunds will be allowed once a purchase in completed.

3.9

Manage account: change pins, block account, link/replace a card.

You can use the card to perform the following card transactions and your account will either be debited or credited:

3.10 Withdraw cash from an ATM or a participating merchant.

3.11 Buy goods and services at merchants which allow for a purchase with a Airtel Money Pesa Card.

The following will apply to the balance of cash that you have in your account at any time and the daily and monthly limits on the amounts of cash in your
account that can be used for wallet transactions and card transactions:

3.12 You can only withdraw, transfer or make payments up to Kenya Shillings 70,000 per transaction or up to Kenya Shillings 140,000 with a day or as
.
may be prescribed by the law from time to time.

3.13 You can only withdraw, transfer or make payments up to a maximum of Kenya Shillings 1,000,000 per month

3.14 The amount of cash in your account must not exceed the above limits as prescribed at any given time.

4. If you exceed the applicable limits or do not have sufficient cash in your account, your transactions may be declined and your account may be restricted
or suspended.

We may send you an SMS to notify you of all transactions on your account with a unique reference number to identify specific transactions for reference
purposes.

Any cash sent to an unregistered user that does not have an Airtel Money account that is not claimed by the person it was transferred to within the time
provided for by the law, will be automatically be sent to the Authority responsible for unclaimed assets as provided for by the law.

5. Declined transactions may result in a fee being levied against your account. If the decline fees take your account into a negative balance, we may recover
those funds from your account when funds are next available in your account.
6. You specifically consent to the use and disclosure of your personal information to Airtel Networks accurately:
7. 7.1. For the purposes of providing Airtel Money services to you

7.2. To/from local and international law enforcement or any competent regulatory or governmental agencies to assist in the prevention, detection or
.
prosecution of criminal activities or fraud.

7.3. To our legal advisors, financial advisors or auditors, or to the applicable court in connection with any legal or other proceedings.

8. We reserve the right to suspend or close your account and revoke your card for any reason, including:
9. 9.1. If we suspect or have obtained proof of the improper and/or unauthorised use of your account, card and/or Airtel Money (including any contravention
.
of any laws or this agreement by you).

9.2. If you choose to port your current Airtel cellphone number to another mobile operator and are no longer our subscriber.

9.3. If you do not transact on your account for a period of 90 days or more.

9.4. In the event of your death, your next of kin can contact our offices near you to be assisted in the process of obtaining any money held in your
.
account with Airtel Money.