Revised in October, 2022

CBO NEW

MINISTRY OF LABOUR AND SOCIAL PROTECTION

STATE DEPARTMENT FOR SOCIAL SECURITY & PROTECTION
DIRECTORATE OF SOCIAL DEVELOPMENT

APPLICATION FORM FOR REGISTRATION OF A COMMUNITY BASED ORGANIZATION (CBO)

AS PER THE COMMUNITY GROUPS REGISTRATION ACT, NO. 30 OF 2022.

COUNTY CONSTITUENCY SUB-COUNTY WARD

1. (a)Basic Information of the Community Based Organization (CBO)

Name of Community Based Organization…………...........……........................................................................

Type of CBO (Tick one) □ New □ Amalgamation

If Amalgamation, (list the forming groups).

1. Registration No. …………………………………………Group name……………………………………..

2. Registration No. …………………………………………Group name……………………………………..

(If more than 2 groups attach a separate list)

Area of Coverage (not more than one county)……………………………………………………….....……

Division………………………………...................... Location…………………………………………..…
Sub Location………………………………………. Year of Formation…………………………………..
Postal Address…………………………………….. Physical Address……………………………………
Email……………………………………….……….. Telephone……………………………………………
Website (where applicable)……………………………………………………………………………………

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(b) Who mobilized your members to seek official registration?
□ Self
□ Officer from social development office
□ Other ministry`s staff
□ CBO
□ NGO
□ Chief
□ Others………….Indicate the person/official

2. Official Meetings

Meeting Venue…………………..........…….... Meeting Day(s)……….............Time..................................

3. Membership of the CBO

Female Male Intersex Total
Total Number of members at
the time of registration
Number of Persons with
Disabilities (PWDs)
Number of Youth (18-35
years)
Number of Older Persons (60+
years)
TOTAL

4. Management Committee
Date elections were conducted:……………..................Method of voting:………………………………..
Elections Venue:……………………..Supervised By:…………………………………Title:…………………
Contact Address/Tel. No:…….…………………Confirmed by:………………………....……………………
Title:....…….……………. Contact Address/Tel. No:…….………………………………..
No Position Name of Person F M ID/No. Tel/Email Signature
1. Chairperson
2. Secretary
3. Treasurer

4. V/Chairperson

5. V/Secretary

Committee
6.
Member
Committee
7.
Member
*Attach a separate list of all committee members if more than seven (7)
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5. CBO Project Objectives

i...……………………………….....................................................................................................................................

ii………………………………...........................................................................................................................

iii………………………………………………………………………………………………………………..

6. Activities of the CBO

a) Type of activity(ies) - tick as appropriate
1. Community project
2. Community Empowerment
3. Community Advocacy
4. Crop farming
5. Cultural/traditional activities
6. Environment Conservation
7. Financial services
8. Fishery
9. Health care
10. Livestock rearing
11. Poultry keeping
12. Skills development
13. Tourism
14. Youth empowerment
15. Merry-go-round
16. Table banking
17. Other(s)

b) Specify the main activity

……………………………………………………………………………………………………………….

7. Future Plans/Activities (if any)

i. ……………………………......................................................................................................................

ii. .……………………………….... ………………………………………………………………………

iii. ………………………………...................................................................................................................

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8. Assistance from the Government/Other Organization(s)

Assistance received so far ……………............………..

Type (Can Tick multiple) □ Financial □ Technical □ Material

Source of Assistance......………………………………….....................……...........................................

How does the CBO intend to fund its activities?

□Members Contributions □Loans □Donations □Grants □Others……………………......................

9. Applicants Signature

Position □ Chairperson □ Secretary □ Treasurer

Chairperson
Name……………………………………………… Telephone…………………………………………
Signature…………………………………………. Date……………………………………………….

Secretary
Name……………………………………………… Telephone…………………………………………
Signature…………………………………………. Date……………………………………………….

Treasurer
Name……………………………………………… Telephone……………………………………………
Signature…………………………………………. Date…………………………………………………

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 FOR OFFICIAL USE
1. Recommended by

□ NGAO Officer(Mandatory)

Name…………….................................................Location/Sub-location ………………………………

Signature ……………...........................................Date ..................................Stamp………..…………..

□ Relevant Technical Ministry/Department

Name of the Officer……………………………………..Title…………………………………………….

Signature …………………………..Date………………………… Stamp……………………………….

2. Approved and Registered by the County Coordinator/ Sub-County Officer for Social Development*
Name……………........................................Title:…………………….…………

Signature………………………………....Date………………………………..Stamp……………….

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 REQUIREMENTS FOR REGISTRATION OF A CBO
1. Name search

2. Minutes of the meeting seeking registration and showing elected officials MUST be attached to the
Application form.

3. List of members duly signed with Name/Position/ID No./Mobile No. and Signatures MUST be
attached to the Application form.

4. The Application form MUST be accompanied by the CBOs Constitution.

5. Attach ID Copies of all members

6. The Application form MUST be accompanied by a Memorandum of Understanding (MOU) where

CBO is formed through amalgamation (i.e. where several groups come together to form an umbrella
organization).

7. Attach the original certificates of the affiliate group who are amalgamating.

8. Pay Approved Registration fee of Ksh.5, 000/=.

After registration, the CBO MUST adhere to the following;

i. Renew the Certificate Annually
ii. Submit Quarterly Progress Reports to the Registering Authority
iii. Allow accessibility of records to the Registering Authority upon request or when demanded to do so

NOTE: Failure to adhere to the above requirements will lead to Non-registration/De-registration