EMPLOYEEBIODATAFORM

PERSONALDETAILS
Surname Mutanu FirstName Diana Middle Mueni
Name(s)
Id Number 42581804 D.O.B 26 12 2004 Gender M ✓ F
Postal Address Zip Code 00100 Area Mkunga Area

Cell No. 0740281506 Alternative 0789648694 Email DIANAMUENI461@GMAIL

No. Address
Nationality Kenyan Dual Nationality (If
Applicable)
Current Dandora1
Residence(e.gCourtX,Phase2,Buruburu)
Permanent Residence

DEPENDENTSDETAILS
Surname FirstName MiddleName(s) DateOfBirth IdNo. Relationship PhoneNumber
Kimuyu Lilian Mutanu 27/12/1981 21971622 Mother 0708867160

BANKDETAILS
BankName StanbicBank AccountNumber

AccountName Branch

STATUTORYDETAILS

KRAPINNo. A021209349Y NSSFNo. 2056762243

NHIFNo. CR32634303546496
 EMPLOYEEBIODATAFORM

NEXTOFKINDETAILS
Name LiianMutanu IDNumber 21971622
Relationshiptoyou Mother Tel.No. 0708867160
Emailaddress

Name IDNumber
Relationshiptoyou Tel.No.
Emailaddress

FORMALEDUCATION(Listcurrentormostrecentas#1,nextmostrecentas#2,etc.)
NameofInstitution AreaofStudy PeriodAttended City,Country QualificationsAwa
From To rded
1. Next Step Foundation Kibera Sep202 Oct2024 Nairobi Certificate
4
2. Ready Aiders Foundation Huruma Aug202 Dec202 Nairobi Certificate
3 3
3. Zawadi Secondary School Eastleigh 2019 2022 Nairobi Certificate

4.

5.

6.

OTHER TRAINING DETAILS(Anyadditionaltrainingbeyondtheformaleducationmentionedabove)

Type of Training Programme(s)Completed PeriodAttended
From To
1. Dreams Core 2020 2022

2.

3.

4.

PREVIOUSEMPLOYMENTDETAILS(Listcurrentormostrecentas#1,nextmostrecentas#2,etc.)
JobTitle NameofEmployer DatesWorked RefereeName,ContactDetails
From To
1. Customer Representative R&G Perfumery&Nails April202 Sep204 Ruth
Parlour 4
2. Sales Girl Tuluba Beddings Jan2023 March202 Peter
3
3.
4.

5.

6.

7.

DeclarationofCriminalrecord

Haveyoueverbeenconvictedofacriminaloffenceorbeenthesubjectofacaution?

YesNo✓

Ifyes,pleasestatethenatureanddatesoftheoffence(s):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

DeclarationofAcceptanceofTermsandConditionsofEmployment

IagreetothefollowingStatements:
 Icertifythatalltheinformationgivenhereinaretothebestofmyknowledge,trueandcomplete

 Iauthoriseinvestigationofallinformationprovidedinthisdocumentasmaybedeemednecessary

 IundertaketopromptlynotifytheHumanCapitalofficeshouldtherebeanychangeintheparticulars
statedabove

 Iunderstandthatfalseandmisleadinginformationmayresultinterminationofmyemploymentwit
hCCIKenyaLimited

 ThisservestoconfirmthatIherewithacknowledgethatIhavebeenadvisedofandunderstandtheab
ove-mentionedtermsandconditions

07/03/2025
Signature:………………………………………. Date:……………………………………………..
 EMPLOYEEEMERGENCYMEDICALINFORMATIONFORM

Incaseofamedicalemergencythefollowingkeyinformationwouldbeofgreatvaluetoattendingm
edicalpersonnelinhelpingtodiagnoseandtreatamedicalproblem.KindlycompletethisCONFIDE
NTIALformwhichwillbekeptinyourpersonalfiletobeusedonlyinthecaseofamedicalemergency.
ThisformshouldbereturnedtoHumanCapitalDepartmentuponcompletion.
Diana Mueni Mutanu
EmployeeName:_________________________________________________________

Dandora
PhysicalAddress:_______________________HomeTelephone:_______________

Who should be notified incase of a medical emergency?

Lilian Mutanu
Name:_____________________________________City:___Nairobi_______________________
Dandora 1
PostalAddress:_______________________HomeTel:______________________________

0708867160
BusinessTel:_____________________________Cell:_______________________________

NameofPersonalPhysician

Name:__LilianMutanu_____________________________City:___Nairobi_____________
Dandora 1
PostalAddress:_______________________Telephone:_____0708867160____________________
_____

PreferredHospital:___N/A_____________________________

Doyouhaveanyknownallergies?Yes________No_____✓_____

Ifyes,pleaselistthethingsyouareallergictoincludinganymedication:
__

___

Doyoutakeanymedicineregularly?Yes________No_____✓___

Ifyes,pleaselistthenameofmedicines
___________________________________________________________________________

___________________________________________________________________________
Doyouhaveanychronicailments?Yes_______No____✓____

Ifyes,pleasedescribe: ___

___

Whatisyourbloodtype?_______O_______________________________________________

Howmanytimeshaveyouvisitedamedicalfacilitywithinthelast12months?

TNone✓ T 1-4times5- T9times T Above10times

Ifmorethanonce,whattreatmentwereyoureceiving?
___________________________________________________________________________

Doyousufferforanyformofdisability?Ifyes,pleasedescribe

NO ___

___

Otherinformationyoufeelisimportantforthismedicalrecord

N/A ___

___

Declaration
Igivemyemployertheright,inthecaseofamedicalemergency,toprovidetheaboveInformationto
attendingmedicalpersonnel.

Employee Name:__________________________________
Mutanu Diana Mueni

Employee Signature: _________

07 / 03/ 2025
Date: _________

ThisformmustbefilledbyallemployeesofCCIKenyaandkeptinemployee’sPersonalFile
 CCIKENYALTD
NOMINATIONOFBENEFICIARIESFORM

InstructionsonfillingtheForm

GeneralInstructions
1. TheformshouldbefilledinCAPITALLETTERS
2. Anytimeanemployeechangeshis/
herbeneficiariesthesameshouldbeupdatedbyfillinganewform.
3. TheformshouldbefilledandsubmittedtoHumanCapitalSharedServices.

SectionB:BeneficiariesDetails
1. Forabeneficiarybelowtheageof18years,aGuardianmustbeappointedfortheinterest
oftheminor.

SECTIONA:PERSONALDETAIL

MUTANU DIANA MUENI

Employee’s FullName____________________________________________________________
(Surname) (FirstName) (MiddleName)

SINGLE 0740281506
EMP.No.____________________MaritalStatus________________MobileNo.____________________
[email protected] 00100
EmailAddress____________________________PostalAddress_____________Code___________
OM
Nairobi
Town_______

SECTIONB:BENEFICIARIESDETAILS

Name Relationship MobileNo. Proportion(%)

LILIAN MUTANU MOTHER 0708867160 100%

GUARDIANDETAILS(Forbeneficiariesbelow18years)

Name Relationship MobileNo.

SECTIONC:EMPLOYEE’SDECLARATION

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.

7/3/2025
Employee’s Signature:__________Date:_________________________________