Integrated Agriculture Management Information System for Trade

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Dealer (Business) Information:

Dealer Type:*	Individual Limited Company Clearing and Forwarding Agent Cooperative Association Sole Proprietor Partnership Religious Institution Non Governmental Organization		Dealer Full Name:*
Trade Name:			Dealer Language:*	Swahili English
Mobile Number (For Notification Purpose):*			Telephone Number:
Dealer Email Address:			Fax Number:
Tax Identification Number:*			Attach TIN:	Choose
Certificate Of Incorporation Number:			Attach Certificate of Incorporation:	Choose
Business Licence Number:			Attach Business Licence:	Choose
Vat Registration Number:			Attach VAT Registration Certificate:	Choose
Registration / Incorporation Date:			Region:*	Dar-es-Salaam Tanga Arusha Kilimanjaro Manyara Geita Mara Mwanza Kagera Shinyanga Simiyu Dodoma Singida Tabora Kigoma Katavi Iringa Mbeya Rukwa Ruvuma Njombe Pwani Mtwara Lindi Morogoro Mjini Magharibi Kusini Unguja Kaskazini Unguja Kusini Pemba Kaskazini Pemba
District:*			Ward:
Village:			Physical Address:*
Postal Address:*

User (Personal) Information:

Full Name:

Email Address (Use this for Login):*

Phone Number:

Password:*

Confirm Password:*

Remarks:

© Ministry of Agriculture, 2017