Dealer Application Form
  1. Please Attach two color passport photographs with this document.
  2. Last Name:(*)
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  3. First Name:(*)
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  4. Middle Name:(*)
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  5. Age:(*)
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  6. Address(Postal):(*)
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  7. Telephone No.(Office/Home):(*)
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  8. Mobile Number:(*)
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  9. Married/Single:(*)
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  10. Number Of Children Below 18yrs old?(*)
    Enter numerical answers only
  11. EDUCATION(School & Location)
  12. High School(*)
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  13. From:(*)
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  14. To:(*)
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  15. Course Study:(*)
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  16. College:(*)
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  17. From:(*)
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  18. To:(*)
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  19. Course Study:(*)
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  20. University:(*)
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  21. To:(*)
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  22. From:(*)
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  23. Course Study:(*)
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  24. WORK EXPERIENCE AND INTEREST.
  25. Present Employer(*)
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  26. Position Held:(*)
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  27. Monthly Salary:(*)
    Enter only numerical figures
  28. Any Experience in the following Activities
  29. Sales
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  30. Employee/Training;(*)
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  31. Clerical:(*)
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  32. Employee/Training:(*)
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  33. Accounting:(*)
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  34. Employee/Training:(*)
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  35. Supervision Of Employees:(*)
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  36. Employee/Training:(*)
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  37. Motor Trade/Service Station Business:(*)
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  38. Employee/Training:(*)
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  39. Do You Own Any Other Business? Yes/No. If Yes Please Explain.(*)
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  40. Are You or Your Employer providing products,goods,services to OIibya? If Yes,Explain(*)
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  41. Does Blood or Marriage relate you to any employees of Olibya? Yes/No. If Yes,Explain(*)
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  42. Have You worked for Oilibya or any other Oil company before? Yes/No. If so,when and where?(*)
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  43. Do You have a preference for a particular town/suburb? Yes/No. If Yes,is your application limited to your stated choice only?(*)
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  44. How Soon do you wish to lease a Service Station?(*)
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  45. Are You agreeable to your application being filled against the possiblity of an opportunity rising in:
  46. 6 Months:(*)
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  47. 1 Year:(*)
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  48. 2 Years:(*)
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  49. Longer:(*)
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  50. FINANCIAL ANALYSIS:
  51. Capital available to invest in business:Ksh(*)
    Enter numerical answers only!
  52. Do You Own Any property? Yes/No. If Yes,type and Location:(*)
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  53. Current Valuation:Ksh:(*)
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  54. Bonds,If Any?(*)
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  55. Current Valuation:Ksh:(*)
    Enter numerical values only!
  56. Bankers:(*)
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  57. Attorneys:(*)
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  58. PERSONAL REFERENCES (Please provide any three)
  59. 1.Name:(*)
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  60. Address/Telephone:(*)
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  61. Position Held:(*)
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  62. 2.Name:(*)
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  63. Address/Telephone:(*)
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  64. Position Held:(*)
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  65. 3.Name:(*)
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  66. TRADE REFERENCES (Please Provide any three)
  67. Position Held:(*)
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  68. 1.Name:(*)
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  69. Address/Telephone:(*)
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  70. Address/Telephone:(*)
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  71. Type Of Business:(*)
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  72. 2.Name:(*)
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  73. Address/Telephone:(*)
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  74. Type Of Business:(*)
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  75. 3.Name:(*)
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  76. Address/Telephone:(*)
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  77. Type Of Business:(*)
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  78. Any other relevant information?
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  79. Please use this to Upload the Passport photograph(*)
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