Form BN/2 - BN-ZMCVDRXZ

(r,4)

THE REGISTRATION OF BUSINESS NAMES ACT, CAP. 499

STATEMENT OF PARTICULARS
(Please read carefully the notes overleaf)
1. Business name: BN-ZMCVDRXZ
2. Nature of business: Healthcare / Medical facility
3. Address of the principal place of business: Building/Plot No/House Number:nakuru , Street: nakuru , Phone Number:
+254710241066
4. Postal address: P.O. BOX 15731 - 00100 - G.P.O NAIROBI .
5. Address of any other place of business:(Branch Office under the above name)
6. Particulars of proprietor or partners -

Date
Full Nationality and of Usual Place Other Business
Name Citizenship Birth Gender of Residence Or Occupation Signature

MARVIN 1993-
Kenyan M nakuru business
OCHIENG 08-31

STATUTORY DECLARATION
(Under section 7)
(to be made only in cases where all partners do not sign above statement)
I, ...................................................................... of............................................................................... do solemnly and
sincerely declare that the particulars set out herein are true and correct and I make this declaration conscientiously
believing the same to be true and according to the Oaths and Statutory Declarations Act. Declared at.......... This.... day
of........,20...

BEFORE ME
Signature_________________________________________________
Magistrate or commissioner for Oaths