FORM 14
REP UBLIC OF KENYA
THE KENYA CITIZENSHIP AND IMMIGRATION ACT 2011
APP LICATION FOR REGISTRATION AS A CITIZEN OF KENYA BY MIGRANT
Under Section 16
I……………………………………………………………………………….…of………………
…………………………………………………………………..hereby make an application for
registration as a citizen of Kenya under Section 16.
PARTICULARS OF AP P LICANT
1. Full name ……………………………………………………………………………………..
2. Place and date of birth…………………………………………………………………..…….
3. Nationality at birth (if any)…………………………………………………………...……....
4. If nationality was lost state circumstances under which it was lost
…………………………………………………………………………………………..…....
…………………………………………………………………………………………..…….
5. Contacts (Postal address, email, telephone) in Kenya
…………………………………………………………………………………………....……
6. Occupation ……………………………………………………………………………….……
7. Father ’s full name and address……………………………………………………………......
8. Father ’s nationality …………………………………………………......................................
(If deceased, give nationality at time of death.)
9. Mother’s full name and address…………………………………………………………..…..
………………………………………………………………………………………………....
10. Mother ’s nationality ………………………………………………………………………....
(if deceased, give nationality at time of death.)
11. If original name has been changed give particulars ………………………………………….
………………………………………………………………………………………………...
12. Marital status (single, married, separated, widowed or divorced)
…………………………………………………………………………………………………
13. If married give date and place of marriage ……………………………………………………
14. Name and nationality of spouse……………………………………………….........................
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15. Give particulars of children:— (Use separate sheet where necessary)
Name of children Date of Place of Birth Where now Citizenship
Birth resident
16. Give details of previous residence in Kenya.
Place From (Date) To (Date) Address Years Months
DECLARATION BY APP LICANT
I ……………………………………………………………………do solemnly and sincerely
declare that the information given in this application is true within my knowledge.
………………………………
Signature of Applicant.
Declared at ……………..………..this ……..day of …….…………20..….
…………………
Before me
*(Magistrate/Commissioner for Oaths)
*Delete as applicable
Note that you shall be called upon to demonstrate your declaration.
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FOR OFF ICIAL USE ONLY
Documents produced: -
Birth certificate if born in Kenya …………………………………………………….…..…
Certificate of good conduct……………………………………………………………….…
Other documents .....................................................................................................................
Receiving officer…………………………….Date ……………. Signature………………………
NB: Applications under section 15, 16 and 17 shall only be made within five years from
th
30 August, 2011.
