Headworld Lins Ltd

FULL NAME *

PAYMENT NUMBER (MPESA NUMBER) *

NATIONAL ID NUMBER *

NUMBER OF LINES DONE *

TEAM NAME *

TEAM LEADER FULL NAME *

SUPERVISOR FULL NAME *

AREA OF OPERATION *

MONTH BEING PAID *

I declare that the information I have provided is true, accurate, and complete. I confirm that the phone number, National ID Number, and payment details belong to me. Where I used a MOBIGO device, I confirm that the MOBIGO MSISDN, IMEI Number, and Login Number are correctly provided. Where I used my personal phone, I confirm that the phone number(OTA) used for registration is correctly provided. I understand that payment will only be processed after verification of approved quality lineS DONE and the details submitted. I acknowledge that providing false or misleading information may result in delayed payment, rejection of my claim, or disciplinary action.