OFFICE OF THE PRESIDENT Application No. sss ACA. -M.R.No. Fee paid... To be completed in capital letters 1. Sub-county of birth 2. County of birth... 3. Notification No... 4. Exact place of birth... 5. Name of child 6. Date of BINH cence 7. Sex of child. 8. Full names of father... 9. Names,of mother before marriage 10. Name of applicant and address Signature... Mobile phone No. Applicant's name... N FORM B4 DEPARTMENT OF CIVIL REGISTRATION APPLICATION FOR BIRTH CERTIFICATE } | soDate.. Cashier's Sign... | For official use only | 1. Entry No. } | 2. Description of informant. j 3. Name of registering officer... | a 4. Date of registration .. 5. Record checked by. 6. Date checked... 7. Signature 8. Fee paid 9. Assessed by... } 10. Date assessed... : 11. Signature... —— { 12. Approved by sc. 13. Date approved... 14, Signature... Mobile phone No. Date Of Bitth osonnnnnnnnnnnee Child’s name... Date presented ... pplication number...