MINISTRY O F L A B O U R A N D SOCIAL P R O T E C T I O N

STATE D E P A R T M E N T FOR SOCIAL P R O T E C T I O N

SOCIAL ASSISTANCE UNIT

BENEFICIARY / C A R E G I V E R UPDATE M A N A G E M E N T F O R M
CT-OVC • PWSD-CTn OP-CTD

Programme No.:

1. BASIC INFORMATION
Name (In Full) V ^ M A ^ a ^ V ^ W > 4 \ L A |BENEFICIARY) I.D. No. LHS$3 S ex M
Phone No.: (Personal / Family Member's / Neighbor's)
Name (In Full)_ (CURRENT CAREGIVER) I.D. No. Sex
Phone No.: (Personal / Family Member's / Neighbor's)

2. CASE TYPE
Payment related: • Carding: • Targeting & enrolment • Updates: •

3. CATEGORY OF UPDATES (PLEASE ATTACH RELEVANT DOCUMENTS)

3.1 Change of Caregiver • , 3.5 Exit of Household •

3.2 Death of Beneficiary r X ^ ^ 3.6 Correction of Household CG/Beneficiary details •
3.3 New Household Member • 3.7 Proof of life •
3.4 Exit of Household Member • 3.8 Other Changes (Specify)

4. NEW CAREGIVER DETAILS

Name (In Full)_ LD. No. Sex

Phone No.: (Personal • / Family Member's • / Neighbor's •) Relation to the Beneficiary.....
Details / Reason for Change:

5. DECLARATION (Beneficiary/Caregiver)

1/ (Beneficiary / Caregiver) hereby

Declare that the information given above is true to the best of my THUMB PRINT
knowledge, arid confirm this by signing / appending my signature
or thumb print.

6. DECLARATION BY THE OFFICER

I, \^)C\Q^&^ Wgx&v.un (Sub County Childrens* Officer/Sub County e

fficer) herfcb
Social Development Officer) hereby declare that the information given above is true
to the best of my knowledge, and confirm this by signing/ appending my signature
or thumb print.

Designation: S<^£^> County VACAV-AASIX/^ _Sub-County:

DateA^V^ .Signature:.
J E A R / . C U T O F F ALONG T H t t - U N E r . T H I PORTION T O BE GIVEN JO.THE .CLIENT.

Serial No. Case type .Programme No,

Form Received By:

Name: .Designation:.

County_ .Sub-County: Date: Signature:.

CALL TOLL-FREE HELPLINE No.: 1533
 REPUBLIC OF KENYA
T H E BIRTHS A N D DEATHS REGISTRATION ACT
(Cap. 149)
PERMIT FOR BURIAL
Serial N o .

1. N A M E O F DECEASE^psl.G.i^E.1.^ MJlUU. u
First Name , Middle Name. Falhc
2. I D E N T I F I C A T I O N /PASSPORT NUMBBR2)...kf}.< h . f e g f e &
SEX: M a l ^ • F e r a a ^ D 5. A G E ... 6. DATE OF DEATH . . . 4
Years/Months/Days 9*\%\2XO-*
. U S U A L R E S I D E N C E /..,C..w..:...X.£. U^u.^..^ {hXu.U.^
Sub-location or estate and (own Sub-cou
fter m a k i n g due inquiry as to cause o f the death of the above named deceased person, I hereby authorize 1
,7 D A T E I^JIM 18. REGISTRATION ASSISTANT FOR: 18. SI
(Name of Sub-location)
Day/MonuV Year

IKJ Fti-fe^ Kljj \ ID No SIGN A T I

REPUBI.lt OF K E N Y A
T H E BIRTHS A N D DEATHS REGISTRATION ACT
(Cap. i4«)