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Birth Certificate Application form

This document is an application form for the late registration of a birth in Kenya, requiring detailed information about the child, parents, and the applicant. It includes sections for personal details, certification by local authorities, and payment information. Additional documentation may be required if the assistant chief's certificate is not available.

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13 views

Birth Certificate Application form

This document is an application form for the late registration of a birth in Kenya, requiring detailed information about the child, parents, and the applicant. It includes sections for personal details, certification by local authorities, and payment information. Additional documentation may be required if the assistant chief's certificate is not available.

Uploaded by

KOECH LEN
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 B3

Republic of Kenya

DEPARTMENT OF REGISTER-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 fathers name (surname)

2. Date of birth…………………………………………………………………………………………………. Sex: male/female


Day mouth year

3. Place of birth…………………………………………………………………………………………………………………………………………..
Kijiji and sub-location or street and town district

4. Name of father…………………………………………………………………………………………………………………………………………
First name tribal (middle) name fathers name (surname)

5. Name of mother………………………………………………………………………………………………………………………………………..
First name tribal (middle) name fathers name (surname)

6. Year of birth of mother………………………………………………………………………………………………………………

B. Applicant
1. Name
…………………………………………………………………………………………………………………………………………………..
First name tribal (middle) name fathers name (surname)

2. Address…………………………………………………………………………………………………………………………………………

3. Relationship to child …………………………date………………………………………………………………………………………….


Signature

C. Certificate
(To be signed by assistant chief of sub-location and countersigned by chief of location)

1. 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.E.A

D. FOR USE OF DISTRICT REGISTRAR


Fee of KSH……………………………………………….Paid refer to cash receipt no…………………………………….

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

…………………………………………………………………………………………………………………………………………………..
*deleted inapplicable.
* * of certificate from assistant chief is not obtainabi, a baptismal certificate or clinical art or doctor’s / midwife’s certificate should be produced.

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