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R…………………………
Receiving Officer
OMBI LA KUTAKA PASPOTI YA KENYA
APPLICATION FOR A KENYA PASSPORT
Signature.………………………. Stamp …………………………. Majina Kamili }
Full Names
Indexing Officer
Tafadhali soma maagizo kwa makini kabla ya kujaza fomu
Please read instructions carefully before completing the form
Signature.………………………. Stamp …………………………. 1. Maelezo: Tafadhali ufahamu vyema kwamba wale wote wanaoomba
1. Instructions. Kindly note that all applicants must complete all Sec-
Sehemu ya 3, ni lazima kujazwa na mwombaji ambaye ni mwanamke Section 3 must be completed where the applicant is married and evi- 2. Upendekezi wa ombi. Mwombaji lazima apendekezwe katika se-
2. Recommendation of application. The application must be recom-
hemu ya 7 na mwananchi wa Kenya kama vile mhuduma wa kidini, mended in Section 7 by a citizen of Kenya, such as a minister of relig- daktari, mwanasheria, mtumishi wa serekali wa cheo cha juu au ion, a medical or legal practitioner, an established civil servant or bank mtumishi wa benki ambaye anamfahamu mwombaji, lakini asiwe ja- official personally acquainted with the applicant but not by an imme- 3. Picha. Picha tatu zilizopigwa hivi karibuni lazima ziambatane na
3. Photographs. Three copies of a recent photograph of the applicant
fomu. Picha hizi lazima ziwe za uso wote, bila kuvaa kofia au kitam- must be taken full face without hat, and the photographs must not be baa. Pia picha isiwe ndani ya fremu. Ukubwa wa picha usizidi inchi 2 mounted. The size of the face must not be more than 2 ½ inches by 2 ½ kwa inchi 2 upana wala usipungue inchi 2 kwa inchi 1 ½ . Ni lazima inches or less than 2 inches by 1 ½ inches. The photographs must be picha hizi ziwe katika karatasi nyembamba ya kawaida ya picha na printed on normal thin photographic paper and must not be glazed. wala isiwe inang’ara. Kwa upande wa nyuma wa picha moja, The recommender is supposed to endorse on the reverse side of one anayependekeza aandike maneneo yafuatayo: Ninathibitisha kwamba copy of the photograph with the words:” I certify that this is a true picha hii ni sura hasa ya muombaji passpoti, Bw./Bi./Bint. likeness of the applicant Mr. /Mrs. / ………………….………….” Na atie sahihi yake. Ms…………………………………………and add his/her signature. 4. Ada hivi sasa ya paspoti ya kurasa 32 ni Sh. 4,500, kurasa 48 ni
4. The current fee for a 32 page passport is Sh. 4,500, 48 page pass-
Sh.6,000, kurasa 64 ni Sh. 7500, Diplomatic ni sh. 7,500 , paspoti ili- port is Sh.6,000, 64 page passport is Sh.7,500, Diplomatic Sh. 7,500, yopotea ni Sh. 12,000, paspoti iliyoharibiwa ni Sh. 10,000 na paspoti Lost passport Sh. 12,000, Mutilated passport Sh. 10,000 and EA pass- ya EA paspoti Sh. 900. Ni lazima malipo haya yawe fedha taslimu au port Sh. 900. This fee must be paid in cash or by bankers’ cheque and 5. Fomu ya maombi ipelekwe na mwenye kuomba binafsi katika Ofisi
5. Application for a passport must be submitted personally by the
kuu yapaspoti, Nyayo House, Nairobi, Mombasa (Uhuru na Kazi applicant to the Passport Control Office, Nyayo House, Nairobi, or to Building), Kisumu (Reinsurance Plaza), au Eldoret (Public Works), the Branch Passport Control Offices,:- Uhuru Na Kazi Building, Garissa, Nakuru(Ofisi ys PC), Embu( Ofisi ya PC) katika muda usio- Mombasa, New PC’s Office Kisumu, Public Works Building, El- pungua siku 20 kabla ya tarehe ya kusafiri. doret, Garissa, Nakuru PC’s office and Embu PC’s office at least 20 days before the scheduled date of travel. Forms may be downloaded 6. Paspoti haiwezi kutolewa au kuongezwa muda wake hapa nchini kwa
from www.immigration.go.ke
niaba ya mtu ambaye tayari yuko nje ya Kenya. Mtu huyo anapaswa kuwasilisha ombi lake kwenye ofisi ya ubalozi wa Kenya uliyo karibui 6. A passport cannot be issued or renewed by a Passport Control Offi-
naye, na katika nchi ambako Kenya haina uwakilishi wa kibalozi, cer on behalf of a person already abroad. Such persons should apply to katika ofisi ya ubalozi wa Uingereza iliyo karibu naye. Paspoti hazi- the nearest Kenya Mission abroad or, where there is no Kenya repre- sentative, to the nearest United Kingdom Mission. Passports are not sent out of Kenya by post. 7. Hati za kuonyesha ni raia wa Kenya ni lazima zitolewe.
7. Documentary evidence of Kenya citizenship must be produced.
8. Fomu zote za maombi ya paspoti ziambatanishwe na paspoti ya
awali kama ipo, Kitambulisho cha Kenya aina ya kisasa, cheti cha ku-
8. All applications must be accompanied by a previous passport, if any
zaliwa na kopi za kila moja ya hati hizi ambazo zimethibitishwa. or current national Kenya Identity Card, Birth Certificates plus certi- 9. Habari zote zitakazotolewa zitahifadhiwa kama siri ya serikali na
9. Information will be treated confidentially and shall not be passed to
any unauthorized persons.
TUMIA HERUFI KUBWA
TO BE COMPLETED IN BLOCK CAPITALS
Maelezo ju ya muombaji
Description of applicant
Iwapo jina limebadilishwa kwa sababu nyingine mbali na ya ndoa, If name has been changed other than by marriage, state original name: ………………………………………………………………………… Postal Address …………………………………………………. Nambari ya simu Tel. No. ………………………………………………… ………………. Ins. ……………… a) Eneo la Makazi au Mtaa/Estate /Sublocation……………………. Rangi ya Macho } …………………………………………………………………………. Colour of eyes ………………………………. b) Nambari ya Ploti/Plot No/ Hse. No./ Kijiji/ Village c) Nambari ya simu ya Nyumbani/Home Tel No . ……………………. Special peculiarities: d) Barua Pepe/Email address …………………………………………. ………………………………………………………………………e) Simu ya Mkono/Mobile phone Number ……………………………. ……………………………………………………………………… (2) Mwananchi wa Kenya kwa: (Chagua neno lifaalo) Father’s Full Name…….……………………………………… Identity Card No. ………….…………………………………. Nambari ya Hati/Certificate No. ……………………….………. Nambari ya Paspoti (au Rno.) Passport No. (or Rno.)….…………………………………… Tarehe ya Kutolewa/Date of issue ……………………………. Place of Father’s birth: ……………………………………… P.O. Box ……………………………………. Taja kama umeoa/olewa, hujaolewa Umetaliki/Talikiwa/Umetengana au Mjane: d) Nambari ya Simu/Tel ………………………………………… Married, Single, Widowed, Separated or Divorced: …………………………………. Mother’s Full Name …….…………………………….………. …………………………………………………. Identity Card No. ………….………………………….………. Passport No. (or Rno.)….……………………………………… …………………………………………………. Place of Mother’s birth: ……………………………………… P.O. Box …………….………………………. …………………………………………………. d) Nambari ya Simu/Tel ………………………….……………… Reason for travel…….………………………………………. (5) Watu wa kupashwa habari dharura jambo linapotokea Particulars of Next of Kin (Person who may be contacted in case of emergency) Full Names ………………………………………………Tarafa/ Division……………………Kata/ Location…………………………. Uhusiano naye/Relationship….……………………………………………………………………………………………………………. Nambari ya Kitambulisho chake /ID No.……………………………… S.L. P/P.O Box………………………………………Tel …………………………….E-Mail………….………………………………. Full Names…. ……….………………………………….Tarafa/ Division………………….…Kata/ Location…………………………. Uhusiano naye/Relationship….……………………………………………………………………………………………………………. Nambari ya Kitambulisho chake/ID No.……………………………… S.L.P/P.O Box………………………………………Tel …………….………………E-Mail…………….…………….………………. Particulars of legitimate /legally adopted child /children (7) MDHAMINI(Tazama maelezo ya kujaza nambari 2 na 3 )

Natoa uhakikisho kwamba anaeomba paspoti ni mtu ninaemfahamu binafsi na kwamba naamini maelezo alioandika hapa ni ya kweli. Mimi ni mwananchi wa Kenya.
RECOMMENDER ( refer to notes no.s 2 and 3 )

I certify that the applicant is personally known to me, and that to the best of my knowledge/ belief the facts stated in this form are correct. I am a citizen of Kenya Majina Kamili Full Names: ……………………………………………………………………. ID No. (Attach certified copy): …………………………. Kazi Profession/Occupation: ………………………………………………………… E-Mail……………………………………………………. Anwani Address P. O. Box: ……………………………………………………………. Tel: ……………………………………………………… Signature: ……………………………………………………………………… Date: ……………………………………………………. (8) UAMUZI

Mimi niliyetia sahihi yangu hapa naomba nipewe paspoti. Naidhinisha: - (a) Kwamba maelezo yaliyotolewa katika fomu hii ya maombi ni ya kweli nijuavyo mimi mwenyewe na kuamini. Kwamba sijapata uraia wa nchi nyingine. Kwamba sijawahi kuwa na, au kuomba paspoti yoyote au (d) Kwamba pasi zote nilizopewa nimerudisha isipokuwa paspoti au cheti cha kusafiri No: …………………………………. ambayo /ambacho kiko pamoja na fomu hii ya maombi, tena sijapeleka maombi mengine ya pasi tangu nipewe paspoti au cheti hiki cha kusafiri. (Futa kwenye mstari “C” au “D” yale yasiyokuhusu) That the information given in this application is correct to the best of my knowledge and belief. That I have not acquired citizenship of another country. That I have not previously held or applied for a passport of any description. That all previous passports granted to me have been surrendered other than passport or travel document No. ……………. Which is now attached, and that I have made no other application for a passport or travel document was issued to me. I (Emigrant/ Parent/ gurdian)…………………………………. of P.O. Box ………………………………………….and I.D Number ………………… …………. hereby agree to bind myself to pay the Government any charges and expenses (including expenses of repatriation from overseas of the Emigrant and Dependants, if any) which may be incurred by the Government of Kenya in respect of myself. (Delete “C” or “D” whichever is inapplicable) Signature: …………………………………………………………. Date: ………………………………………………………………… FOR OFFICIAL USE ONLY
Documents produced
Applicant’s Birth Father’s/Mother’s Grandparent’s Birth Child(ren) Birth Marriage CATEGORY OF PASSPORT TO BE ISSUED
Ordinary Passport: East African Passport: Service Passport: Certificate of Identity & Nationality Temporary Passport Applicant’s ID No…………………………………. Verified By………………………………………. Passport No………………………………………. Issued on …………………………………………. Serial No…………………………………………. Recommending officer: Approving officer: Name: ……………………………. Name …………………………………. Name …………………………. Signature …………………………. Signature ……………………………… Signature ……………………… Date ………………………………. Date ……………………………………. Date: ………………………….

Source: http://www.forms.co.ke/forms/110_Immigration_Passport%20Application_Form%2021A.pdf