___________________________________________________________________________________________________________________ |
Date of entry into Kenya (attach passport in useduring this period): | |
___________________________________________________________________________________________________________________ |
State if continuously in Kenya for a period of two years immediately before and two years after child’s birth (attach passport in use during this period): | |
___________________________________________________________________________________________________________________ |
If a permanent resident give reference No. of father’s certificate of residence: | |
___________________________________________________________________________________________________________________ |
Number of personal tax receipt issued to father during the year of child’s birth (attach copy): | |
___________________________________________________________________________________________________________________ |
3. INFORMATION REGARDING CHILD’S MOTHER |
___________________________________________________________________________________________________________________ |
Date and Place of Birth: | |
___________________________________________________________________________________________________________________ |
Date of entry into Kenya (attach passport in use during this period): | |
___________________________________________________________________________________________________________________ |
State if continuously in Kenya for a period of two years immediately before and two years after child’s birth (attach passport in use during this period): | |
___________________________________________________________________________________________________________________ |
If a permanent resident give reference No. of mother’s certificate of residence: | |
___________________________________________________________________________________________________________________ |
Date of marriage of child’s mother to father (attach certificate): | |
___________________________________________________________________________________________________________________4. In support of the application please produce as many of the following documents as may be available—Municipality notification of birth, Hospital certificate, Midwife’s certificate, Baptismal certificate, Horoscope, Community certificate, School certificate or other real evidence of the date and place of birth. |
Affidavits are not sufficient___________________________________________________________________________________________________________________ |
It should be particularly noted that affidavits are NOT required and will not be accepted.___________________________________________________________________________________________________________________5. State why birth was not registered at the time___________________________________________________________________________________________________________________ |
|
6. Dated this ......................................... day of .........................................................., 20 ........................... |
Signature of applicant | |
............................................................................. | |
| Full name and postal address of applicant......................................................................................................... |
7. Sworn at .................... this ............ day of ..............., 20 .............. |
Before me .................................................................................................... |
(Registrar or Magistrate) |
.......................................................signature |