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1. Application forms are available Free of Charge at the Kiambu NG CDF Office &other designated
points.
2. The following documents MUST be attached to the application form.
a) Fees structure for the Current Academic Year.
b) Current Report Form
c) Death certificate (For Orphans and students whose any of the parents is deceased)
d) Copy of voters card
e) Any other relevant supporting documents
3. The fully filled bursary form should be returned to the Kiambu NG CDF Office on or before
4th March 2019
A. PERSONAL INFORMATION
Name of Student……………………………………………………………………………………………………………………………
Sex: Female ( ) Male ( ) Date of Birth ………………………………………………………………………..
County.……………………………………………..Ward …………………………………………………………………………………
Location………………………………………………Sub-Location: ………………………………………………………………………
Address: ……………………………………………….Phone No: …………………………………………………………………………..
B. INSTITUTION INFORMATION
Name of Institution ………………………………………………………………………………………………………………..…………
Reg./Adm.no. …………………………….…………………Year/Form 1( ) 2( ) 3( ) 4( ) Others …………….
Course taken……………………………………………………………………. Duration ………………………………………………….
C. FEES DETAILS
(a)Fees for the (b)Previous Term/year (s) (c)Amount paid/Able to pay in Balance =
Current Term outstanding balance the current term - Including (a) + (b) – (c)
Funds from Other Financiers
D. FAMILY INFORMATION
STUDENT’S DECLARATION
I declare that the information given here in is true to the best of my knowledge.
Student Signature ……………………………………………. Date ……………………………………………………………………….
PARENT/GUARDIAN’S DECLARATION
I declare that I understand the content of this form and that the information given here in is true to
the best of my knowledge and belief
Parent/Guardian’s Signature…………………………………………….. Date ………………………………………………..
SCHOOL’S CERTIFICATION
I confirm that the applicant is a registered student in this school and that the information given here
in above regarding school fees and performance is true
Signature ……………………………………………………..….Date………………………………………………………………….
Name ………………………………………………………….……Designation………………………………………………………
School’s Official Stamp …………………………………………………………………………………………………………………
Remarks ……………………………………………………………………………………………………………………………..........
……………………………………………………………………………………………………………………………………………………
CHIEF/RELIGIOUS LEADER’S CERTIFICATION
I certify that the personal and family information given here in is correct
Signature………………………………………………………..Date……………………………………………………………………
Name……………………………………………………………..Designation ………………………………………………………..
Official Stamp ……………………………………………………………………………………………………………………………..
Remarks ……………………………………………………………………………………………………………………………………..
Reason(s) …………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………………..