OFFICE

OF THE PRESIDENT
CIVIL REGISTRATION SERVICES

APPLICATION FOR A BIRTH CERTIFICATE CBC-V7S3AY3

FORM B4 FEE: 180 DATE: TUE 14 MARCH 2023

TO BE COMPLETED IN CAPITAL LETTERS FOR OFFICIAL USE ONLY

TYPE OF APPLICATION NEW ENTRY NUMBER

COUNTY OF BIRTH NAIROBI APPLICATION NUMBER

EXACT PLACE OF BIRTH KENYATTA NATIONAL HOSPITAL PRINT DATE

NAME OF CHILD HUGHSTANLEY OMINDE KUBOKA NAME OF REGISTERING OFFICER

CHILD ABOVE 18? NO RECORD CHECK BY

DATE OF BIRTH 15-05-2012 ASSESSED BY

SEX OF THE CHILD MALE APPROVED BY

ENTRY OR NOTIFICATION NUMBER

DETAILS OF FATHER AVAILABLE? YES

NAME OF THE FATHER CAROLINE WAIRIMU WANJIRU

ID NUMBER OF THE FATHER 23748974

DETAILS OF MOTHER AVAILABLE? YES

NAME OF THE MOTHER FREDRICK KUBOKA AMAYO

ID NUMBER OF THE MOTHER 22984157

NAME OF THE GUARDIAN

ID NUMBER OF THE GUARDIAN

ADDRESS OF THE APPLICANT NAIROBI

SIGNATURE

APPLICANTS NAME FREDRICK KUBOKA AMAYO TELEPHONE NO +254722353247

DATE PRESENTED TUE 14 MARCH 2023 PICK UP LOCATION ACK BISHOP