Form 23

APPLICATION FOR PERMANENT RESIDENCE

Under Section 37

AFFIX PHOTO

PART I

1. Full name:

........................................................................
2. Contact details (Physical address/postal address/email/telephone)

....................................................................................................................

3. Place of birth ........................... Date of birth ..........................................

4. Nationality ............................... Passport No(s)......................................
Date and place of issue of passport(s) ............................................................
5. Full name of spouse ...................................................................................
6. Particulars of children, full names, sex, date and place of birth:
(a) ..............................................................................................................
(b) .............................................................................................................
(c) .............................................................................................................
(d) .............................................................................................................
(e) .............................................................................................................

PART II

To be completed by or in respect of:-

(a) Persons who were citizens by birth and have since renounced or otherwise lost their
citizenship status.

i. Date and circumstances under which citizenship was lost

………………………………………………………………………………………………

(b) Persons who have held permits for at least seven years and have been continuously
resident
 i. Details of permit(s) held for the last seven years preceding the date of this
application.

…………………………………………………………………………………………
…………………………………………………………………………………………

ii. Place or places of residence for the last seven years preceding the date of
this application

………………………………………………………………………………………….

iii. Have you ever been the subject of a removal order issued against you in
Kenya at any time? If yes give details

………………………………………………………………………………………….

(c) Children of citizens who are born outside Kenya and have acquired citizen of their
domicile

i. Place and date of birth………………………………………..

ii. Circumstances under which citizenship lost
……………………………………………………………………………..

(d) Spouses of Kenyan citizens married for at least three years

i. Name, passport/ID number of the Kenyan spouse

………………………………………………………………………………….

ii. Date and place of marriage (Attach evidence of marriage)

…………………………………………………………………………………….

iii. Current immigration status

……………………………………………………………………………………..

iv. Place or places of residence for the last three years preceding the date of this
application

…………………………………………………………………………………………

v. Have you ever been the subject of a removal order issued against you in Kenya
at any time? If yes give details
 ………………………………………………………………………………………….

DECLARATION

I ……………………………………………………………………do solemnly and sincerely

declare that the information given in this application is true and within my knowledge.

Declared at …………………..this……..day of …………………20…………….

…………………
Signature of Applicant.

Before me

………………………………………………..
*(Magistrate/Commissioner for Oaths.)
*Delete as applicable.

File Reference number……………….