OFFICE

OF THE PRESIDENT
CIVIL REGISTRATION SERVICES

APPLICATION FOR A BIRTH CERTIFICATE CBC-JKS8WZQ

FORM B4 FEE: 180 DATE: WED 25 JANUARY 2023

TO BE COMPLETED IN CAPITAL LETTERS FOR OFFICIAL USE ONLY

TYPE OF APPLICATION NEW ENTRY NUMBER 0264942203

COUNTY OF BIRTH NAIROBI APPLICATION NUMBER 001258692

EXACT PLACE OF BIRTH MATER HOSPITAL PRINT DATE

NAME OF CHILD HAVENRUBY TATIANA OUKO NAME OF REGISTERING OFFICER

CHILD ABOVE 18? NO RECORD CHECK BY

DATE OF BIRTH 05-07-2019 ASSESSED BY

SEX OF THE CHILD FEMALE APPROVED BY

ENTRY OR NOTIFICATION NUMBER

DETAILS OF FATHER AVAILABLE? YES

NAME OF THE FATHER TIMOTHY OCHIENG OUKO

ID NUMBER OF THE FATHER 14506956

DETAILS OF MOTHER AVAILABLE? YES

NAME OF THE MOTHER BEATRICE AKINYI OLOO

ID NUMBER OF THE MOTHER 24196481

NAME OF THE GUARDIAN

ID NUMBER OF THE GUARDIAN

ADDRESS OF THE APPLICANT BURUBURU ESTATE

SIGNATURE

APPLICANTS NAME BEATRICE AKINYI OLOO TELEPHONE NO +254720676228

DATE PRESENTED WED 25 JANUARY 2023 PICK UP LOCATION ACK BISHOP