Your Personal Details
Please input your personal details below

(Mr/Miss/Mrs)

Your Surname e.g. Doe

Your First name e.g. John

Your Middle name

(DD/MM/YYYY)

National ID No.

e.g. A123456

e.g. Kenyan

(Male/Female)
Your Account Details
The details below will enable you to access your application in the future

e.g. john.doe@domain.com

Our Terms and Conditions
Please read the terms and conditions below before proceeding forward:
Warning: All information submitted will be verified. Incomplete information may delay processing; incorrect information may result in rejection of application.

I agree and acknowledge that by submitting this application that Collection Africa is entitled to conduct all and any credit checks which it may deem necessary, at any time it deems necessary, with any information supplier/s of its choice, as to establish the credit worthiness of the applicant, and by submitting this application, I duly authorise all and any such checks and any relevant information provided by such credit reference bureaus and/or financial institutions to be given to Collection Africa Limited.

Fields marked * are mandatory