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B3-Form Compress

This document is an application form for late registration of a birth in Kenya. It requests information about the child such as name, date and place of birth, and names of the parents. It also requests information about the applicant filing the application such as their name, address, and relationship to the child. Finally, it includes a section to be signed by local government officials to certify the accuracy of the personal details provided, and a section for the district registrar's use to record payment of the application fee.

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kelvinwanjo2018
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61 views

B3-Form Compress

This document is an application form for late registration of a birth in Kenya. It requests information about the child such as name, date and place of birth, and names of the parents. It also requests information about the applicant filing the application such as their name, address, and relationship to the child. Finally, it includes a section to be signed by local government officials to certify the accuracy of the personal details provided, and a section for the district registrar's use to record payment of the application fee.

Uploaded by

kelvinwanjo2018
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORM B3

REPUBLIC OF KENYA
____________

DEPARTMENT OF THE REGISTRAR-GENERAL


____________

APPLICATION FOR LATE REGISTRATION OF A BIRTH


Please complete
complete this and return it, together w
with
ith the corre
correct
ct fee to the Di
District
strict Regis
Registrar
trar in your dis
district.
trict.

A. INFORMATION REGARD
REGARDING
ING THE CHILD

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

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


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

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

B. APPLICANT

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


for……………………………………………………………., …………., hereby certify that I h have
ave 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 U
USE
SE OF DISTRICT REGISTRAR
REGISTRAR

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

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

……………………………………………………………………………………………………………………………………………………
*Delete inapplicable.
* *If certificate from Assistant Chief is not obtainable, a baptismal certi ficate or clinical card or doctor’s/midwife’s certificate should be produced.
____________________________
GPK (SP) 7393—100m—07/2008
7393—100m—07/2008

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