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    B3 Form

    Uploaded by

    Mavoco Marvin
    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, parents' names. It also requests information about the applicant filing the form such as their name, address, and relationship to the child. The form must be signed by an assistant chief to certify the personal details are true, and then submitted to the district registrar along with the correct fee.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    B3 Form

    Uploaded by

    Mavoco Marvin
    1K views2 pages
    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, parents' names. It also requests information about the applicant filing the form such as their name, address, and relationship to the child. The form must be signed by an assistant chief to certify the personal details are true, and then submitted to the district registrar along with the correct fee.

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    154925451-B3-FORM

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    © © All Rights Reserved

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    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, parents' names. It also requests information about the applicant filing the form such as their name, address, and relationship to the child. The form must be signed by an assistant chief to certify the personal details are true, and then submitted to the district registrar along with the correct fee.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1K views2 pages

    B3 Form

    Uploaded by

    Mavoco Marvin
    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, parents' names. It also requests information about the applicant filing the form such as their name, address, and relationship to the child. The form must be signed by an assistant chief to certify the personal details are true, and then submitted to the district registrar along with the correct fee.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    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………………………………………………..

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

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