[B)PARENT'S, I declar given is true, Name... Mobile No... }/ GUARDIAN'S DECLARATION e that I have read this form or this form has been read to me and hereby confirm that information UNIVERSITY BURSARY FORM Signature/thumb print D) PRINCIPAL'S/REGISTRAR’S DECLARATION (1) Year of Admission... (1) Academic performanee ‘Semester/Term Ill... Semester/Term I (iv) Student's Discipline: Date: | (Certify the attached copy of transcript) Below Average Excellent! Very Good [—] Good Average (ji)Total Fees Outstanding KSH: Excellent: [] Very Good [—] Good Fair poor [_] (v) Principal's/Dean/Registrar’s comments on the level of need. Name. nner Mobile No..... Account particulars: Name of bank: ... Bank code: ... Signature... +» Email Br Address... snch: Date... (Tick one option only) .Rubber stamp. sgcount number: NB: PLEASE NOTE THAT THIS IS VERY IMPORTANT FOR WIRING FUNDS FOR SUCCESSFUL APPLICANTS. NO CHEQUES WILL BE ISSUED E) CHIEF/ ASSISTANT CHIEF'S OR RELIGIOUS LEADER'S REMARKS ON THE STATUS OF THE FAMILY/PARENTS AND DISABILITY OF THE STUDI boast aoe CASE Si a ENT (if any) ot od Page 4 ofS