LTGS Connector Registration Form
First Name
Last Name
National ID
Date of Birth
Gender
--Select--
Male
Female
Martal Status
--Select--
Single
Married
Divorced
Separated
Widowed
Other
Email Address
Phone Number
Residence Province
--Select--
Kigali City
Northern
Southern
Eastern
Western
Residence District
--Select--
Gasabo
Kicukiro
Nyarugenge
Burera
Gakenke
Gicumbi
Musanze
Rulindo
Gisagara
Huye
Kamonyi
Muhanga
Nyamagabe
Nyanza
Nyaruguru
Ruhango
Bugesera
Gatsibo
Kayonza
Kirehe
Ngoma
Nyagatare
Rwamagana
Karongi
Ngororero
Nyabihu
Nyamasheke
Rubavu
Rusizi
Rutsiro
Residence Sector
Residence Cell
Residence Village
Next
Parent Agent Reg ID
Verify
Agent Full Names
AgentBusiness Name
Business TIN Number
Agent Phone Number
Agent Email Address
Agent Relationship
--Select--
Assistant
Employee
Co-Founder
Connector
Other
Profile Operator Level
--Select--
Initiator
Viewer
Processor
Controller
Profile Operation Status
--Select--
Active
Inactive
Submit Request