Scribd
Upload
489 views

b3 Form

This document is an application form for late registration of a birth in Kenya. It requests information such as the child's name, date and place of birth, parents' names and details. The applicant provides their name, address and relationship to the child. The form is to be signed by an assistant chief to certify the details, then countersigned by a senior registration assistant. It includes sections for payment of the registration fee and signature of the district registrar. The purpose is to officially register a birth that was not registered within the standard time period.

Uploaded by

HUDUMA CYBER CAFE
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
489 views

b3 Form

This document is an application form for late registration of a birth in Kenya. It requests information such as the child's name, date and place of birth, parents' names and details. The applicant provides their name, address and relationship to the child. The form is to be signed by an assistant chief to certify the details, then countersigned by a senior registration assistant. It includes sections for payment of the registration fee and signature of the district registrar. The purpose is to officially register a birth that was not registered within the standard time period.

Uploaded by

HUDUMA CYBER CAFE
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 2

FORM B3

REPUBLIC OF KENYA

DEPARTMENT OF THE REGISTRAR-GENERAL

APPLICATION FOR LATE REGISTRATION OF A BIRTH


Please complete this and return it, together with the correct fee to the District Registrar in your district.

A. INFORMATION REGARDING THE CHILD

1. NAME………………………………………………………………………………………………………............................
First name Tribal (middle) name Father’s name (surname)

2. DATE OF BIRTH……………………………………………………………3.SEX: Male/Female*


Day Month Year

3. PLACE OF BIRTH………………………………………………………………../……………………………………..........
Kijiji and sub-location or street and town District

4. NAME OF FATHER…………………………………………………………………………………………………………………………………............
First name Tribal (middle) name Father’s name (surname)

5. NAME OF MOTHER ………………………………………………………………………………………………………………………...


First name Tribal (middle) name Father’s or husband’s* name (surname)

6. YEAR OF BIRTH OF MOTHER………………………………

B. APPLICANT

1. NAME………………………………………………………………………………………………………………………………………………………...
First name Tribal (middle) name Father’s or husband’s * name (surname)

2. ADDRESS……………………………………………………………………………………………………………………………………………............

3. RELATIONSHIP TO CHILD…………………………………..4. .DATE ………………………………5. ……………………………………......…….


Signature.

C. CERTIFICATE

(To be signed by Assistant Chief of sub-location and countersigned by Chief of location* *)

I, Registration Assistant for…......................................................................................., hereby certify that I have knowledge of the personal
Name of sub-location
details of the child named in the above application and that, to the best of my knowledge, the facts given are true.

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


Date Signed by R.A. Countersigned by S.R.A.

D. FOR USE OF DISTRICT REGISTRAR

Fee of KSh………………………………………………paid. Refer to Cash Receipt No. ………………………………………

Date……………………………………………… Signature………………………………………………..

……………………………………………………………………………………………………………………………………………………
*Delete inapplicable.
* *If certificate from Assistant Chief is not obtainable, a baptismal certificate or clinical card or doctor’s/midwife’s certificate should be produced.

GPK (SP) 7393—100m—07/2008

You might also like