FORM RB 5(A)

REPUBLIC OF KENYA

___________________

ENGINEERS BOARD OF KENYA

___________________ No …………..

FORM OF APPLICATION FOR

REGISTRATION AS A GRADUATE ENGINEER

THE REGISTRAR
ENGINEERS BOARD OF KENYA
P. O. BOX 30324 - 00100
NAIROBI

Surname ……………………………………………………………………………....……
All inform-
tion to be Other Names …………………………………………………………………………..…
Printed in the
English Title (Dr., Mr., Mrs., Miss) …………………………………………………………..……
Language.
Birth date ………………………………………………………………………..…………

Nationality ……………………………………………………………………………….…

Postal address ……………………………………… Tel: ………………………………...

Email Address ……………………………………………………………………………..

Academic qualifications ………………………………………………………………..…..

Discipline …………………………………………………………………………..……..

Name of employer and address …………………………………………………………....

………………………………………………………………………………………………
EDUCATION:

Diploma/Degree Month and

School or University Location From To
Received Year

Note:- The application must be accompanied by two coloured Passport Size Photos, certified copies of
the original diploma/degree Certificate, ‘O’ Level certificate and a copy of the National ID/Card or
Passport all duly certified by a Commissioner of Oaths whose names and address are fully displayed on
the Rubber Stamp.

1. I attach my application fee of Ksh. 1000/= payment of which I understand is not refundable.
2. I hereby certify that the foregoing statements are true and correct and that I have read the
Engineers Act, 2011 and understand that, if registered, I shall be bound thereby and by any
amendments thereto so long as my name remains on the Register for Graduate Engineers.

Signature …………………………………..

Date ………………………………………
_________________________________________________________________________
Deposit receipt No ……………………… Date of Registration ………………..…….
For office
Use only. Registration Number……………..… Candidate Notification Date ….…….……