To be retained by the Presenter

QUADRUPLICATE

The Conditions on the Back of this Form shall be Complied with

REPUBLIC OF KENYA
IN THE MATTER OF THE LAND ACT NO. 6 OF 2012
AND
IN THE MATTER OF THE LAND REGISTRATION ACT NO. 5 OF 2012
AND
IN THE MATTER OF THE REGISTERED LAND ACT CHAPTER 300
( NOW REPEALED )
APPLICATION FOR REGISTRATION
I hereby apply for the registration of the under mentioned instruments in the following order of
priority:-

Date of Instrument Description Title Number Fee For Official

Use only

Please issue land Certificate/ Certificate of lease

Additional fee Sh. 5, Sh. 25 each

P.O./ M.O/ Cheque attached hereto the value of Sh.

The following documents are enclosed:-

Land Certificate Divisional Land Control Board Consent
Certificate of Lease Chargee’s consent in terms of the charge
Lease (duplicate and triplicate)
Charge (duplicate and triplicate) ………………………………………….
Clearance Certificate ………………………………………….
Estate Duty Certificate ………………………………………….
Lessor’s consent in terms of lease
Special instructions, including in appropriate cases the name and address of the person to
whom the documents are to be sent if other than the presentor:-

………………………………………………………………………………………………
……………………………………………………………………………………………....
Signature …………………………………..
Name in Block Capitals …………………..
Postal Address …………………………….
Date ……………………………………………. 20……………………………………….

(The conditions on the back of this form must be complied with)