FIRST SCHEDULE
APPLICATION FORM FOR LICENCE
PART I (to be completed by the applicant)1.Personal Information(a)Full name of Applicant ....................................................(b)Name of Institution (if applying for institutional permit and attach CV of researchers) .................................................(c)Approving Authority (e.g. CEO, Director) ..................................(d)National Identification Number (lD No.)/Passport No. ......................(e)Physical Address...........................................................(g)Contacts:Telephone ............................ Fax.....................................Mobile No. ....................................................................E-mail ........................................................................(i)Highest Qualification .....................................................(Please attach the above details and Curriculum Vitae for other researchers in your team)2.Personal References(Give names and full addresses of two senior academic/professional referees, These should be professionally qualified in the field of research which the applicant wishes to undertake)(i)Name......................................................................Address........................................................................Profession/Occupation..........................................................Contacts:Tel:............................. Mobile.......................................Fax............................................................................E-mail.........................................................................(ii)Name......................................................................Address........................................................................Profession/Occupation..........................................................Contacts: .....................................................................Tel:...........................................................................Fax............................................................................E-mail.........................................................................3(a)Have you applied for a licence to conduct research in Kenya before? Yes/No(b)If (a) above is yes, provide the title of the recent research previously applied for.........................................................................................................................................................................................................................................................................................................................................................................................................................(c)If the application was approved vide the Licence, No.........................................................................................................................................................................Dated..............................................(d)If the application was rejected vide the application. No......................................................................................................................................................................Dated ...............................................4.Title of the research project.......................................................................................................................................................................................................................................................................................................................................(a)Source(s) of finance....................................................................................................................................................................(b)Amount of currency....................................................................................................................................................................6.Purpose of the research...............................................................................................................................................................................7.Location of research:Location/Division ........................................................................County .....................................................................................8.Estimated period of the project: from.........................to...................9.Do you need access to the Public Records? (if yes list)...............................................................................................................................................................................10.Do you need to interview any Government Officials? (if yes list them)...........................................................................................................................................................................................................................................................................11.What research tools (e.g. questionnaire) do you intend to use? (attach copies)......................................................................................................................................................................................I certify that I have read and understood the Science, Technology and Innovation (Research Licensing) Regulations, 2014. I do agree to abide by them as required and that the information given by me in Part I is correct to the best of my knowledge.Signature .................................... Date...................................PPART II(For official use only)Date Application Received.................................................................Signature.................................................................................Receipt Number............................................................................Approved/not approved.....................................................................Date..........................................Signature...................................Secretary, National Commission for Science, Technology and InnovationSECOND SCHEDULE
LICENCE
Application Reference No. ..................................................................Licence No. ...............................................................................This is to certify that the application to conduct research in Kenya received from .................. of P.O Box .............................to the Commission in accordance with Research Licence Regulations to conduct research titled .......................................................................located at ....................................................................... (Locality and county) has been evaluated and a licence is hereby issued, subject to the attached conditions.This License is valid from ..................................... to ........................Dated this ........................day .................... 20 .........................Signature ................................................................................(Official Seal)Commission Secretary National Commission for Science, Technology and InnovationConditions of Licence1.The licence shall only be used for the intended research and the specified period and research site.2.Neither the licence nor any right thereunder shall be transferred, assigned, or disposed of in any manner, either voluntarily or involuntarily, directly or indirectly, through transfer of control of the licence to any person.3.The Commission reserves the right to cancel at any time during the research period if in the opinion of the Commission the research is not implemented in conformity with the provisions of the Act or any other written Law.4.Upon request of the Commission, the licensee shall, at any time before expiration of the licence, submit written statements, signed under oath or affirmation if appropriate, to enable the Commission to determine whether or not the licence should be modified, suspended, or revoked.5.The Licensee shall inform the County Governor in the area of research before commencement of the research, failure to which will lead to cancellation of the licence.6.Excavation, filming and collection of specimens are subject to further permissions form relevant government agencies.7.The Commission reserves the right to modify the conditions of this Licence including its cancellation without prior notice.8.This Licence does not give authority to transfer research materials.
