Eee vipeeyy yr? * BIRTH AUTHORITY SLIP NO canner AfPA, DEPARTMENT OF CIVIL REGISRATION P.0 BOX 49179 NAIROBI THE REGISTRAR OF BIRTHS —— sseevssssesserseseseosteensssnese 2017 LATE BIRTH REGISTRATION OF BIRTHS section 8 of the birch and deaths registration act, authority is and my receipt NO cnn issued. ame of child he evidence produced to me in support of the above information was PR jo owe “pons: roy ydyanes Aw pue 3 ‘ay 40 wor st Atuoygne 438 wonensfias syeap pue SHiuia 40 wvuAsiON 3H 1g0uNWN 6216 KOU O'd NOLVUSIDSY WA JO INSWLNvaaa valor “oN AUOUINY dS ALMMOHLNY Hae 4 ‘ : < m i | adFORM BE OFFICE OF THE PRESIDENT DEPARTMENT OF CIVIL REGISTRATION APPLICATION FOR A BIRTH CERTIFICATE. Application No. Fee Paid sense MER, NO. To be Completed in Capital Leters 1. District of birth 2. Province of birth 43. Notification No. 4. Exact place of birth... 5. Name of hil 6. Date of birth .. 7.Sex of Child 8, Full names of father 9. Name of Mother before marriage 10, Name and address of Applicant Signature Applicant's name (Child's name. Date presented oR Date. Cashiers Sign. For Official Use Only 1. Entry No. 2. Description of informant, 3. Name of registering officer 4, Date ofrepstration 5, Record checked by. 6, Date checked 7. Signature: 8. Fee paid 9. Assessed by 10, Date assessed .. 11, Signatore 12. Approved by 13. Date approved 14, Signature Date of birth Application numberFor B3 REPUBLIC OF KENYA. [DEPARTMENT OF THE REGISTRAR-GENERAL APPLICATION FOR LATE REGISTRATION OF A BIRTH Please complete this and return it, together withthe correct fee tothe District Registrar in your district. |A. INFORMATION REGARDING THE CHILD First name “riba (id) ame ashes name (surname) 2. DaTEOF BIRTH SEX: Male/Female Day Month Year 3. PLACE OF BIRTH. jocation or sret and town, Dist 3 4, NAME OF FATHER First name ‘Tribal (mide) name Fauber’s name (surname) 5. NAME OF MOTHER i First name “Tribal (middle) name Father's or husband’s* nome (surname) 6. YEAR OF BIRTH OF MOTHER APPLICANT, = NAME: z First name “Tribal (mide) name Father's or husband's * name (name) 2. apres 3. RELATIONSHIP TO CHILD. DATE 5 Signatur ccerrinicaTE: (To be signed by Assistant Chief of subocation and countersigned by Chieff location* *) |, Registration Assstan for. «hereby certify that | have knowledge of the personal Name of subccation ‘etal of the child named inthe above application aad tht, othe bet of my knowledge, the facts given are true. Dae Signed by RA. Countersigned by S.A, D. FOR USE OF DISTRICT REGISTRAR Fee of KSh, pid Refer to Cash Receipt No, Date . tes ‘SignasareoP REPUBLIC OF KI vA APPLICATION FOR LATE REGISTRATION OF BIRTH SUPPLEMENTARY QUESTIONNAIRE ‘Supplementary information to be submitted in respect of applicants claiming to be bom in Kenya. 1 (@) Fall Names: (6) Date and Place of Birth (6) Name of Father (d) Fathers Date and Place of Birth () Name and Meiden Name of Mother {f) Mothers Date and Place of Birth 2. (a) Present Residence (©) Location (or ward in Towns): (Name of Chief (a) Name of Sub-Chier: 3. Supporting Documents (2) ldenity Card No. (6) Details of all Passports Held by Father: (©) Details ofall Passports Held by Mother: 4. Certificate by Ass -Chiet hereby certify that I have made enquiries locally and I have checked and found the above particulars to be correct Sub-Location Ass Chief Signature) Date... 5. Certificate by Chief Thereby certify that T have checked with the local elders and find the above particulars to be correct. Location Chief {Signaware) Date 6. Certificate by Divisional Distriet Officer There by cemify that I have checked with location Chief and found the above particulars to be correct, Divisions Date . Divi Officer- Signature) Pg tor2S REPUBLIC OF KENYA opiies APPLICATION FOR LATE REGISTRATION OF BIRTH ‘SUPPLEMENTARY QUESTIONNAIRE 7. Certificate by District Commissioner have checked this application and I am satisfied thatthe applicant was bor in Keny’ District: Date: : District Commissioner (Signature) NOTES FOR GUIDANCE OF OFFICERS MAKING CERTIFICATES, |) Applicants shoutd be asked to produce proof of their own and their parents’ birth which may be in the form of Birth Cert cates or extracts from Church or Community Registers i) The applicants should bring with them the old persons who have personal knowledge of the applicant's and his parents’ birth. (Gii) Applicants should also be examined on their knowledge of the Swahili language and local history. Pezot2 >