Individual Credit Report Request Form (Page 2 of 2) in pdf

Individual Credit Report Request Form Page 2

Kindly state your Reasons for requesting for the Credit Report:

For my own interest.

I was Denied Credit: Name of Institution……………………………………………………………..

Annual Report:

I would like to receive my credit reports and any other correspondence via:

Postal address

I certify that the information/answers and documentation provided in response to the questions

herein are true, complete and authentic.

I understand that the presentation of forged documents or the passing off of any documents issued by a

lawful authority to another person as my own, for purposes of obtaining any right or privilege, is a

criminal offence.

I confirm that I want my credit report delivered to me through the e-mail/postal address

indicated herein and hereby authorize CRBAfrica to mail/deliver/send my credit report to the

e-mail/postal address indicated herein. I release CRBAfrica and its officers, employees and

agents from all claims, actions or proceedings of whatsoever nature and howsoever arising,

suffered or incurred in connection with CRBAfrica sending/delivering/mailing my credit

report to the addresses that I have provided herein.

Name…………………………………………….Date…………………………Sign………………………….

Form:

How to complete the Individual Credit Request

1. Names must appear as they do on ID if Kenyan/Alien Certificate or Passport if alien.

2. ID and PIN certificate are mandatory for Kenyan Nationals; Alien Certificate and

Passport is mandatory for aliens.

OFFICIAL USE:

Verified: ……………………………………………………………………………………………………..

Report generated: ………………………………………………………………………………………….

CRBAfrica Staff Name: ………………………………………Signature: ……………………………….

Date: ……………………………….

Individual Credit Report Request Form Page 2