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FORM B4

This document is an application form for obtaining a birth certificate from the Department of Civil Registration. It requires the applicant to provide details such as the child's name, date of birth, and parental information, along with payment details. The form includes sections for official use to record the registration process and approval status.

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caleb
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5 views

FORM B4

This document is an application form for obtaining a birth certificate from the Department of Civil Registration. It requires the applicant to provide details such as the child's name, date of birth, and parental information, along with payment details. The form includes sections for official use to record the registration process and approval status.

Uploaded by

caleb
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
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FORM B4

DEPARTMENT OF CIVIL REGISTRATION


APPLICATION FOR BIRTH CERTIFICATE

Application for Search/Birth Certificate


Application No………………………… C.A NO………………………… Date………………..….
Fee paid………………………………… M.R No………………………. Cashier Sign……………

TO BE COMPLETED BY APPLICANT IN CAPITAL LETTERS : FOR OFFICIAL USE ONLY.


1. Sub-county of Birth……………………………….. 1. Entry No………………………….
2. County of Birth…………………………….. 2. Description of Information……………
3. Notification No……………………………… ………………………………………..
4. Exact place of Birth …………………………. 3. Name of Registration Officer………..
5. Name of Child………………………………. ……………………………………….
6. Date of Birth…………………………………. 4. Date of Registration…………………..
7. Sex of child…………………………………. 5. Record checked by:…………………...
8. Full Name of Father…………………………. 6. Date checked………………………….
……………………………………………….. 7. Signature……………………………..
9. Name of Mother before marriage………….. 8. Fee paid ………………………………
………………………………………………… 9. Assessed By…………………………..
10. Name and Address of Applicant…………... ……………………………………….
……………………………………………….. 10. Date Assessed………………………
Signature………………………………….. 11. Signature……………………………
Mobile phone No. …………………………… 12. Approved By……………………….
13. Date of approved…………………..
14. Signature……………………………
15. Certificate No……………………

Applicant’s Name…………………...….……………. Mobile Phone No…………………………………

Child’s Name…………….………………………… Date of Birth………………………………………

Date presented………………………………….. APPLICATION NO………………........................

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