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    Form 40

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    toroitich Titus mark

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    © All Rights Reserved
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    Form 40

    Uploaded by

    toroitich Titus mark
    1 views1 page

    Original Title

    Form-40(3)

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    © © All Rights Reserved

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    1 views1 page

    Form 40

    Uploaded by

    toroitich Titus mark

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    K E N Y A V E T E R I N AMobile:

    RY BOARD
    P.O. BOX 513-00605 UTHIRU - KENYA
    0722305253, 0701581718

    Email: [email protected]

    FORM 40 (r. 38 (1))

    APPLICATION FORM FOR REGISTRATION OF INTERNS

    The Registrar,

    The Kenya Veterinary Board,

    Kabete.

    I………………………………….………………………………………………………..

    of P. O Box……………………………………Postal Code………………………………
    hereby make an application for registration as a veterinary surgeon/veterinary
    paraprofessionals (mark as appropriate) intern.

    Telephone Number:………………………………………………………………………

    Email:………………………………………………………………………………………

    Index Number (For Official Use Only):……………………………………………………

    My qualifications are: ……………………………………………………………………..

    ………………………………………………………………………......………………….

    Host organization ……………………………………………………..........………………

    Name of supervising veterinary surgeon ………………………………….


    ………………………………………………………….

    I enclose the following:

    1. Certificate/diploma/degree………………………………………………..
    2. Veterinary surgeon’s/Paraprofessional’s (mark as appropriate) oath as required by
    section 16 (3) of the Veterinary Surgeons and Veterinary Paraprofessionals Act
    3. National ID

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

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