EMPLOYEE BIODATA FORM
PERSONAL DETAILS
Surname First Name Middle
Name(s)
Id Number D.O.B Gender M F
Postal Address Zip Code Area
Cell No. Alternative No. Email Address
Nationality Dual Nationality (If Applicable)
Current Residence (e.g Court X,
Phase 2, Buruburu)
Permanent Residence
DEPENDENTS DETAILS
Surname First Name Middle Name(s) Date Of Birth Id No. Relationship Phone Number
BANK DETAILS
Bank Name Account Number
Account Name Branch
STATUTORY DETAILS
KRA PIN No. NSSF No.
NHIF No.
EMPLOYEE BIODATA FORM
NEXT OF KIN DETAILS
Name ID Number
Relationship to Tel. No.
you
Email address
Name ID Number
Relationship to Tel. No.
you
Email address
FORMAL EDUCATION (List current or most recent as #1, next most recent as #2, etc.)
Name of Institution Area of Study Period Attended City, Country Qualifications
From To Awarded
1.
2.
3.
4.
5.
6.
OTHER TRAINING DETAILS (Any additional training beyond the formal education mentioned above)
Type of Training Programme (s) Completed Period Attended
From To
1.
2.
3.
4.
PREVIOUS EMPLOYMENT DETAILS (List current or most recent as #1, next most recent as #2, etc.)
Job Title Name of Employer Dates Worked Referee Name, Contact Details
From To
1.
2.
3.
4.
5.
6.
7.
Declaration of Criminal record
Have you ever been convicted of a criminal offence or been the subject of a caution?
Yes No
If yes, please state the nature and dates of the offence (s):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Declaration of Acceptance of Terms and Conditions of Employment
I agree to the following Statements:
I certify that all the information given herein are to the best of my knowledge, true and
complete
I authorise investigation of all information provided in this document as may be deemed
necessary
I undertake to promptly notify the Human Capital office should there be any change in the
particulars stated above
I understand that false and misleading information may result in termination of my
employment with CCI Kenya Limited
This serves to confirm that I herewith acknowledge that I have been advised of and
understand the above-mentioned terms and conditions
Signature: …………………………………………………. Date: ……………………………………………..
EMPLOYEE EMERGENCY MEDICAL INFORMATION FORM
In case of a medical emergency the following key information would be of great value to
attending medical personnel in helping to diagnose and treat a medical problem. Kindly
complete this CONFIDENTIAL form which will be kept in your personal file to be used only in
the case of a medical emergency. This form should be returned to Human Capital
Department upon completion.
Employee Name: _________________________________________________________
Physical Address: __________________________ Home Telephone: _______________
Who should be notified in case of a medical emergency?
Name: ______________________________________City: __________________________
Postal Address: _______________________Home Tel: ______________________________
Business Tel: _____________________________Cell: ________________________________
Name of Personal Physician
Name: _________________________________City: ________________
Postal Address: _______________________Telephone: ______________________________
Preferred Hospital: ________________________________
Do you have any known allergies? Yes ________No__________
If yes, please list the things you are allergic to including any medication:
__
___
Do you take any medicine regularly? Yes ________ No________
If yes, please list the name of medicines
___________________________________________________________________________
___________________________________________________________________________
Do you have any chronic ailments? Yes _______No________
If yes, please describe: ___
___
What is your blood type? ______________________________________________________
How many times have you visited a medical facility within the last 12 months?
T None T 1-4 T times T 5-9 times
Above 10 times
If more than once, what treatment were you receiving?
___________________________________________________________________________
Do you suffer for any form of disability? If yes, please describe
___
___
Other information you feel is important for this medical record
___
___
Declaration
I give my employer the right, in the case of a medical emergency, to provide the above
Information to attending medical personnel.
Employee Name: __________________________________
Employee Signature: _________
Date: _________
This form must be filled by all employees of CCI Kenya and kept in employee’s Personal File.
CCI KENYA LTD
NOMINATION OF BENEFICIARIES FORM
Instructions on filling the Form
General Instructions
1. The form should be filled in CAPITAL LETTERS
2. Anytime an employee changes his/her beneficiaries the same should be updated
by filling a new form.
3. The form should be filled and submitted to Human Capital Shared Services.
Section B: Beneficiaries Details
1. For a beneficiary below the age of 18 years, a Guardian must be appointed for
the interest of the minor. Attach copy of National ID for the guardian.
SECTION A: PERSONAL DETAILS
Employee’s Full Name __________________________ _________________________
____________________________
(Surname) (First Name)
(Middle Name)
DCST No. ____________________ Marital Status __________________ Mobile No.
____________________
Email Address ____________________________ Postal Address _____________ Code
___________ Town __________
SECTION B: BENEFICIARIES’ DETAILS
National ID / Birth Date of Birth
Name Relationship Mobile No. Rate (%)
Certificate No. (DD/MM/YYYY)
GUARDIAN DETAILS (For beneficiaries below 18 years)
Name Relationship National ID. Mobile No.
SECTION C: EMPLOYEE’S DECLARATION
I hereby nominate the person(s) listed above to be my preferred beneficiaries, to
receive any lump-sum benefits payable from CCI Kenya Ltd in the proportion(s)
indicated against each beneficiary in the event of my death while in service.
This nomination cancels and replaces any previous nominations signed by me. I
declare that the details given above are to the best of my knowledge and belief
correct.
Employee’s Signature: _________________________________ Date: _______________________
