Membership Application ⇽ BIMS - Bodaboda rider registration

Glue Up account creation information.

Uploading an image is mandatory

Profile Photo *

Please enter a first name

First Name *

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Please enter a last name

Last Name *

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Please enter a valid email address
e.g. john.doe@glueup.com

Email Address *

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Please enter a password that contains at least 8 characters

Password *

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Please enter a password that contains at least 8 characters

Confirm password (at least 8 characters) *

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Please fill in your member application details.

Please enter a first name

First Name *

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Please enter a last name

Last Name *

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Please enter a valid email address
e.g. john.doe@glueup.com

Email *

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Personal Information

Maximum limit reached (255 characters).

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Gender *

Please enter a valid number

Business attendant ID number *

ID / Passport *:Click here to upload a file

Please upload a valid id / passport

Please enter a valid date
e.g. mm/dd/yyyy, dd-mm-yyyy or yyyy-mm-dd

Date of birth *

Certificate of Good conduct:Click here to upload a file

Please enter a valid phone number including country code

Phone *

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Please enter a next of kin name

Next of kin name *

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Please enter a valid phone number including country code

Business owner's contact *

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Please enter a next of kin relationship

Next of kin relationship *

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Please select an option

Marital status *

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Home County *

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MOMBASA 001 *

Please select an option

KWALE 002 *

Please select an option

KILIFI 003 *

Please select an option

TANA RIVER 004 *

Please select an option

LAMU 005 *

Please select an option

TAITA TAVETA 006 *

Please select an option

GARISSA 007 *

Please select an option

WAJIR 008 *

Please select an option

MANDERA 009 *

Please select an option

MARSABIT 010 *

Please select an option

ISIOLO 011 *

Please select an option

MERU 012 *

Please select an option

THARAKA - NITHI 013 *

Please select an option

EMBU 014 *

Please select an option

KITUI 015 *

Please select an option

MACHAKOS 016 *

Please select an option

MAKUENI 017 *

Please select an option

NYANDARUA 018 *

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NYERI 019 *

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KIRINYAGA 020 *

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MURANG'A 021 *

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KIAMBU 022 *

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TURKANA 023 *

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WEST POKOT 024 *

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SAMBURU 025 *

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TRANS NZOIA 026 *

Please select an option

UASIN GISHU 027 *

Please select an option

ELGEYO/MARAKWET 028 *

Please select an option

NANDI 029 *

Please select an option

BARINGO 030 *

Please select an option

LAIKIPIA 031 *

Please select an option

NAKURU 032 *

Please select an option

NAROK 033 *

Please select an option

KAJIADO 034 *

Please select an option

KERICHO 035 *

Please select an option

BOMET 036 *

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KAKAMEGA 037 *

Please select an option

VIHIGA 038 *

Please select an option

BUNGOMA 039 *

Please select an option

BUSIA 040 *

Please select an option

SIAYA 041 *

Please select an option

KISUMU 042 *

Please select an option

HOMA BAY 043 *

Please select an option

MIGORI 044 *

Please select an option

KISII 045 *

Please select an option

NYAMIRA 046 *

Please select an option

NAIROBI CITY 047 *

Please enter a home county

Home County *

Working SubCounty

Business attendant name

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Work Information

Please select an option

Working County *

Please select an option

MOMBASA 001 *

Please select an option

KWALE 002 *

Please select an option

KILIFI 003 *

Please select an option

TANA RIVER 004 *

Please select an option

LAMU 005 *

Please select an option

TAITA TAVETA 006 *

Please select an option

GARISSA 007 *

Please select an option

WAJIR 008 *

Please select an option

MANDERA 009 *

Please select an option

MARSABIT 010 *

Please select an option

ISIOLO 011 *

Please select an option

MERU 012 *

Please select an option

THARAKA - NITHI 013 *

Please select an option

EMBU 014 *

Please select an option

KITUI 015 *

Please select an option

MACHAKOS 016 *

Please select an option

MAKUENI 017 *

Please select an option

NYANDARUA 018 *

Please select an option

NYERI 019 *

Please select an option

KIRINYAGA 020 *

Please select an option

MURANG'A 021 *

Please select an option

KIAMBU 022 *

Please select an option

TURKANA 023 *

Please select an option

WEST POKOT 024 *

Please select an option

SAMBURU 025 *

Please select an option

TRANS NZOIA 026 *

Please select an option

UASIN GISHU 027 *

Please select an option

ELGEYO/MARAKWET 028 *

Please select an option

NANDI 029 *

Please select an option

BARINGO 030 *

Please select an option

LAIKIPIA 031 *

Please select an option

NAKURU 032 *

Please select an option

NAROK 033 *

Please select an option

KAJIADO 034 *

Please select an option

KERICHO 035 *

Please select an option

BOMET 036 *

Please select an option

KAKAMEGA 037 *

Please select an option

VIHIGA 038 *

Please select an option

BUNGOMA 039 *

Please select an option

BUSIA 040 *

Please select an option

SIAYA 041 *

Please select an option

KISUMU 042 *

Please select an option

HOMA BAY 043 *

Please select an option

MIGORI 044 *

Please select an option

KISII 045 *

Please select an option

NYAMIRA 046 *

Please select an option

NAIROBI CITY 047 *

Please enter a working county

Working County *

Please enter a business owner's name

Business owner's name *

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Please enter a business attendant contact

Business attendant contact *

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Please enter a sacco name

Sacco name *

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Zone

Ward chairman name

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Please enter a valid phone number including country code

Ward chairman phone no

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Please enter a valid phone number including country code

Stage Chairman Phone no *

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Building name

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Bodaboda Information

Please enter a business owner email

Business owner email *

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Please enter a frame/ chasis no

Frame/ Chasis no *

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Please select an option

Ownership *

Please enter a ownership names

Ownership names *

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Please enter a valid phone number including country code

Business attendant contact *

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Please select an option

Operation *

DISCLAIMER: I confirm that the information that I have given is correct, accurate and true to the best of my knowledge. I am aware that this information will be used by BIMS to generate a unique QR code and ID after a payment of ksh 500.

I understand that the information may be provided to an authorized government agency/agencies for security purposes and/0r contact my next of kin in case of any emergency.

Do you agree to the disclaimer above? *Yes

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Glue Up account creation information.

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