User Registration – Kirby Browne Resources

Your Kirby Browne Company Email address(Required)

If you don't have a Kirby Browne Company Email address then enter firstname.lastname@kirbybrowne.com (replacing firstname.lastname with your details)

Username(Required)

Please makes this your firstname followed by your surname e.g. tatenda.nyabunze

Password(Required)

Enter Password Confirm Password

Strength indicator

Take a note of this password. You will use to login to the intranet in the future.

Name(Required)

First Last

Gender(Required)

Date of Birth(Required)

National ID No.(Required)

You will be required to upload a copy of your ID at the end of this form

Marital Status(Required)

Number of children under the age of 19(Required)

Do you have a medical aid plan?(Required)

Yes

No

Name of provider(Required)

Plan / Package Name(Required)

Membership Number(Required)

Start Date(Required)

Job Title(Required)

Department(Required)

Job Title (Other)(Required)

Department (Other)(Required)

Your Contact Number(Required)

Your Personal Email Address

Your Home Address(Required)

Street Address Address Line 2 City Country

Bank Name(Required)

Branch

Account Holder's Name(Required)

Account Number(Required)

Details of Your Spouse

Your Spouse's Name

First Last

National ID Number(Required)

Date of Birth(Required)

Details of Your Children

Children under the age of 19(Required)

Name

Gender

Date of Birth

Who should we contact in the event of an emergency whilst at work?

Name(Required)

First Last

Mobile Phone(Required)

Home Phone(Required)

Email(Required)

Copy of your National ID Document(Required)

Max. file size: 10 MB.

New User Registration

Details of Your Spouse

Details of Your Children