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Providers | Register as a CPD Provider
Register as a
CPD Provider
1
Provider Details
2
CPD Administrator
3
Invoice
Use this form if you wish to register as a new CPD Provider with the
Clinical Officers Council
Provider
Details
(mandatory)
---- SELECT PROVIDER TYPE ----
Individual
Institution/Organization
---- SELECT COUNTY ----
MOMBASA
KWALE
KILIFI
TANA RIVER
LAMU
TAITA TAVETA
GARISSA
WAJIR
MANDERA
MARSABIT
ISIOLO
MERU
THARAKA NITHI
EMBU
KITUI
MACHAKOS
MAKUENI
NYANDARUA
NYERI
KIRINYAGA
MURANG'A
KIAMBU
TURKANA
WEST POKOT
SAMBURU
TRANS NZOIA
UASIN GISHU
ELGEYO MARAKWET
NANDI
BARINGO
LAIKIPIA
NAKURU
NAROK
KAJIADO
KERICHO
BOMET
KAKAMEGA
VIHIGA
BUNGOMA
BUSIA
SIAYA
KISUMU
HOMA BAY
MIGORI
KISII
NYAMIRA
NAIROBI
DIASPORA - Other Countries
DECLARATION
I declare that to the best of my knowledge and belief that the particulars I/ we have given in this form are correct and complete.
Pertinent
Attachments
(mandatory)
Certificate of Business Registration (BN3)
Company Profile
Memorandum and Articles of Association
(Signed Page or CR12)
Copy of ID/Passport
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CPD
Administrator
Designation
First Name
First Name
Mobile No
Mobile No
Middle Name
Middle Name
Email
Email
Last Name
Last Name
Address
Postal Address/Code
ID Number/Passport
ID Number/Passport
Town
Town
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