Section 1. Details

Fu I I NameS(Dr,Mr,Mrs,Miss)

Maiden Names

Nationality

Country & Place of Birth

Date of Birth

Education

Marital Status

Passport Numbers

Dates of Stay in Kenya Start Date

Full Address When in Kenya

Address 1

Address 2

City

Country

REPUBLIC OF KENYADEPARTMENT OF IMMIGRATION

APPLICATION FORM FOR A CERTIFICATE OF GOOD CONDUCT(To Be Completed ln Block Letters)

f Single f Married f Divorced f Widowed

Please read the instructions carefully before completing the form

End Date

PostCode

Page 1 of 3

Present Address & Telephone Number

Address 1

Address 2

City

Country

Telephone Number

Present Employment

Father's Full Name

Father's Eull Address

Address 1

Address 2

City

Country

Father's Occupation

Certificate Required For

PostCode

PostCode

SignatureDate

Office Use Only

M.R. Number Date

Page 2 of 3

Please submit the form along with the following documents

NON-KENYAN CITIZENS

1" A completed set of fingerprints which should be taken by local police or any other authorized entity.2. An application letters.3' Attached a bank cheque or Money Order of AUS25 payable to the "Kenya High Commission,,.4. Certified copy of applicant,s passport information page.5. Non-Kenyan citizen should provide a copy of entry/work/resident permit or other endorsement on

passport showing that they stayed for more than 6 months.6' A Prepaid self-addressed registered or express post envelope (residents outside Australia should

include AUS18 for lnternational Registered Envelope) for the return of your documents.7. 2 passport size photos.

8. For those who lived in Kenya as refugees - to provide UNHCR mandate letter.

Note: Processing takes 3 months.

KENYAN CITIZENS

t. A completed set of fingerprints which should be taken by local police or any other authorized entity.2. A certified photocopy of Kenya 2nd generation identity card.3. Attached a bank cheque or Money order of AUS25 payable to the "Kenya High Commission,,, or

payment from e-citizen portal.4. A letter of application.5. Certified copy of applicant's passport information page.6' A Prepaid self-addressed registered or express post envelope (residents outside of Australia should

include AUS18 for International Registered Envelope) for the return of your documents.7. 2 passport size photos.

Note: Processing time takes 3 months.