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To Be Completed in Capital Letters: For Official Use Only

This document is an application for a birth certificate from the Department of Civil Registration. It requests information such as the district and place of birth, names of the child and parents, date of birth, sex of the child, and contact information for the applicant. Officials from the Department would then review the application, approve it, and issue a birth certificate.

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FLORENCE MAKOKHA
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2K views

To Be Completed in Capital Letters: For Official Use Only

This document is an application for a birth certificate from the Department of Civil Registration. It requests information such as the district and place of birth, names of the child and parents, date of birth, sex of the child, and contact information for the applicant. Officials from the Department would then review the application, approve it, and issue a birth certificate.

Uploaded by

FLORENCE MAKOKHA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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FORM B4

OFFICE OF THE PRESIDENT


_____________

DEPARTMENT OF CIVIL REGISTRATION


APPLICATION FOR A BIRTH CERTIFICATE

Application No……………………………CA………………………Date…………………………………

Fee paid……………………………M.R. No………………….Cashier’s Sign. ………………………….

To be Completed in Capital Letters For Official Use Only

1. District of birth……………………………………… 1. Entry No. ……………………………………….

2. Province of birth…………………………………….. 2. Description of informant ………………………

3. Notification No. ……………………………………... …………………………………………………..

4. Exact place of birth …………………………………. 3. Name of registering officer……………………..

………………………………………………………... …………………………………………………...

5. Name of child ………………………………………... 4. Date of registration………………………………


……………………………………………………….... …………………………………………….............
6. Date of birth ……………………………………….... 5. Record checked by ………………………………
7. Sex of child …………………………………….......... …………………………………………………...…
8. Full names of Father……………………...………… 6. Date checked ………………………………………
……………………………………………………….. 7. Signature………………………………………...…
9. Names of mother before marriage 8. Fee paid…………………………………………….
……………………………………………………….. 9. Assessed by ………………………………………..
10. Name of Applicant and address …………………… 10. Date assessed……………………………………….
…………………………………………………….…. 11. Signature……………………………………………
……………………………………………………….. 12. Approved by………………………………………..
Signature ……………………………………………….… 13. Date approved………………………………………

14. Signature…………………………………………….

Applicant’s name ………………………………………………………………………………................................................................

Child’s name ……………………………………..Date of birth………………………………………………………………………..

Date presented…………………………………Application number………………………………………………………..................


_________________
_____
GPK (SP) 7397-250m-7/08

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