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Farmer Registration

Company Name :

Farmer/Company Representative First Name :

Farmer/Company Representative Surname :

Farmer/Company Address :

National ID :

Date of Birth :

Gender :

Email Address :

Contact Cell :

Marital Status :

First Name :

Surname :

National ID :

Cell :

Village :

Ward :

District :

Farm Name :

Farm Size(Hectarage) :

Total Arable Land(HA) :

Area Under Irrigation(HA) :

Farm Implements Available :

Farm Ownership :

Latitude Coordinates :

Longitude Coordinates :

Infrastructure :

Farm Type :

Password :*

Confirm Password :

I declare that the information is complete and accurate.

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