Scribd
Upload
24 views1 page

CBC-WRH47PWP-B4 Form

This document is an application form for a birth certificate for a child named Emmanuel Ombeta, born on May 18, 2022, at Dagoretti Sub District Hospital in Nairobi. The application was submitted by Janetalia Mokua Kerubo on November 21, 2024, with a fee of 180. The details of the father are not available, while the mother's information is provided.

Uploaded by

Phelix
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
24 views1 page

CBC-WRH47PWP-B4 Form

This document is an application form for a birth certificate for a child named Emmanuel Ombeta, born on May 18, 2022, at Dagoretti Sub District Hospital in Nairobi. The application was submitted by Janetalia Mokua Kerubo on November 21, 2024, with a fee of 180. The details of the father are not available, while the mother's information is provided.

Uploaded by

Phelix
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

OFFICE OF THE PRESIDENT

CIVIL REGISTRATION SERVICES


APPLICATION FOR A BIRTH CERTIFICATE
CBC-WRH47PWP

FORM B4 FEE: 180 DATE: THU 21 NOVEMBER 2024

TO BE COMPLETED IN CAPITAL LETTERS FOR OFFICIAL USE ONLY

TYPE OF APPLICATION NEW NOTIFICATION NUMBER 2785174

COUNTY OF BIRTH NAIROBI APPLICATION NUMBER

EXACT PLACE OF BIRTH DAGORETTI SUB DIST HOSP PRINT DATE

NAME OF CHILD EMMANUEL OMBETA NAME OF REGISTERING OFFICER

CHILD ABOVE 18? NO RECORD CHECK BY

DATE OF BIRTH 18-05-2022 ASSESSED BY

SEX OF THE CHILD MALE APPROVED BY

ENTRY OR NOTIFICATION NUMBER

DETAILS OF FATHER AVAILABLE? NO

DETAILS OF MOTHER AVAILABLE? YES

NAME OF THE MOTHER

ID NUMBER OF THE MOTHER

NAME OF THE GUARDIAN

ID NUMBER OF THE GUARDIAN

ADDRESS OF THE APPLICANT KABIRIA

SIGNATURE

APPLICANTS NAME JANETALIA MOKUA KERUBO TELEPHONE NO +254759144083

DATE PRESENTED THU 21 NOVEMBER 2024 PICK UP LOCATION ACK BISHOP

You might also like