Scribd Logo
Upload

Welcome to Scribd!

  • Birth-Certificate Form B3 & B4

    Uploaded by

    presslink
    133K views2 pages
    Kenya Birth Certificate form

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    Kenya Birth Certificate form

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    133K views2 pages

    Birth-Certificate Form B3 & B4

    Uploaded by

    presslink
    Kenya Birth Certificate form

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 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………………………………………………..

    ……………………………………………………………………………………………………………………………………………………

    GPK (SP) 7393—100m—07/2008


    FORM B4

    OFFICE OF THE PRESIDENT

    DEPARTMENT OF CIVIL REGISTRATION


    APPLICATION FOR A BIRTH CERTIFICATE

    Application No.......................................................... CA ………………………………………………... Date……………………...………………....

    Fee Paid …………………………….M.R. No. …………………………………….. ………. Cashier's Sign …………………………….…………….

    To be Completed in Capital Letters For Official Use Only


    1. District of birth ……………………………………………… 1. Entry No. ……………………………………………………...
    2. Province of birth ……………………………………………. 2. Description of informant……………………………………….
    3. Notification No. …………………………………………… …………………………………………………………………….
    4. Exact place of birth …………………………………….…… 3. Name of registering officer
    ……………………………………………………………….. …………………………………………………………………….
    5. Name of child ……………………………………….……………… 4. Date of registration …………………………………………………….
    ……………………………………………..…………………… …………………………………………………………………….
    6. Date of birth ………………………..……………………….. 5. Record checked by …………………………………………….

    7.Sex of Child …………………….…………………………… …………………………………………………………………….


    8. Full names 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 …………………………………………………

    …………………………………………………………………. 11. Signature ……………………………………………………..


    …...….…………………………………………………………. 12. Approved by ………………………………………………….
    Signature ………………………………………………………. 13. Date approved ………………………………………………...
    14. Signature ……………………………………………………...

    Applicant's name …………………………………………………………………………………………………………………………


    Child's name………………………………………………………………………...Date of birth ………………………………………
    Date presented ……………………………………………………………… Application number ……………………………………..

    GPK

    You might also like