NOMINATION FORM

2023 KSF ELECTIONS PHOTO

Please answer each question clearly and
completely.
Type or print in ink.

1. Family Name: First Name/Other Names: 2. Gender: Female (F) or Male (M)

F M
3. Date of Birth (DD/MM/YYYY) 4. Country of Birth 5. Membership Within the KSF

6. Name/Address of Employer 7. Position/Designation Employed In 8. Cellphone & Email Contact

9. Nominated By:
KSF Member Club__________________________________________________________

Name of Chairman/Secretary_______________________________________________

Reg. Number of KSF Member_______________________________________________

Date of Nomination: _______________________________________________________

10. Seconded By: KSF Member Club/School/University______________________________________

Name of Chairman/Secretary_______________________________________________

Reg. Number of KSF Member_______________________________________________

Date Seconded: ____________________________________________________________

11. Check List of Other Required Documents To Be Enclosed Enclosed or Not Enclosed
a) The Nominee’s brief curriculum vitae (CV) Yes No
b) Copies of relevant academic credentials and certificates Yes No
c) Copy of National ID Yes No
d) Recent passport size coloured photograph Yes No
e) Clearance from –
i) the Directorate of Criminal Investigation Yes No
ii) the Kenya Revenue Authority Yes No
Yes No
iii) the Ethics and Anti-Corruption Commission
Yes No
iv) the Credit Reference Bureau Yes No
v) the Higher Education Loans Board.

f) Signed Code of Conduct for the Elections Yes No

g) Proof of payment of Nomination Fee of Ksh 5,000.00 Yes No

I do submit my Nomination for the position on the KSF Executive as indicated, and certify that the information
indicated by me on this Nomination Form is true, complete and accurate and that any misrepresentations or
material omissions may result in my disqualification as a Candidate. I also confirm that I am eligible to stand
for the position, and fulfil the eligibility criteria specified in the Electoral Rules and Guidelines.

Signed by Nominee: _______________________________________ Date: __________________________________________

 2.

For Official Purposes:

Date/Time Received: _________________/__________ Name/Signature of Official:________________________