Part A: Student S Personal Information

KALOLENI NG-C.D.F BURSARY APPLICATION FORM (KNG-C.D.F.B.A.F)

PART A: STUDENT’S PERSONAL INFORMATION

STUDENT NAME AS PER INSTITUTION REGISTER……………………………………………………………….

SEX:MALE ……………FEMALE…………DATE OF BIRTH…………………………………………………..

CONSTITUENCY……………………………………...DIVISION……………………………………………………

LOCATION……………………………………………..SUB/LOCATION…………………………………………..

DO YOU HAVE ANY DISABILITY/CHRONIC ILLNESS?

YES…… /NO…….. NATURE……………………………………..

FATHER’S NAME………………………………………...... ALIVE………DEAD……………….

MOTHER’S NAME…………………………………………………...... ALIVE...... DEAD………………

DOES YOUR PARENT(S) HAVE ANY DISABILITY /CHRONIC ILLNESS? YES/NO IF YES STATE

YES……………/NO………….. NATURE……………………………………………………….

PART B: STUDENT’S INSTITUTIONAL DETAILS

NAME OF THE INSTITUTION IN FULL:…………………………......

POSTAL ADDRESS…………………………………………………….TEL.NO……………………………………….

PHYSICAL ADDRESS OF THE INSTITUTION………………………………………………………………………..

COURSE TITLE………………………………………………YEAR OF STUDY………………………………………

REG/ADM.NO.…………………………………………...... YEAR OF ADMISSION……………………………….

EXPECTED YEAR OF COMPLETION………………………………………………………………………………….

PART C: BURSARY REQUIREMENTS STATUS

ARE BOTH PARENTS ALIVE………….YOUR MOB. NO………………………………………………..

(State if have a single parent supported with death certificate or a letter from Ass. Chief)

WHO PAYS FOR YOUR SCHOOL FEES: PARENTS:……………………………………………………..

SELF…………GUARDIAN…………WELLWISHERS…………………………………………………….

ANNUAL FEES…………………….. OUTSTANDING BALANCE……………………………..,………..

AMOUNT APPLIED………………………………......

(Attach current fee structure/fee statement and report form)

Have you ever benefited from theKaloleni NG-Constituency Development Fund bursary in the past 1year?

YES ………………… NO……………………………………………………..

If yes state the amount Kshs……………………………………………………………………………….

Currently are you a beneficiary of another scheme apart fromKNG-C.D.F. Bursary

Yes………… No……………

IfYES name it…………………………………………………………………………………………………

And how much have you received this financial year? Kshs………………………………………………

D: PROVINCIAL ADMINISTRATION RECOMMENDATIONS

AREA CHIEF/ ASSISTANT CHIEF

Comment on the status of the family/parents…………………………………………………………………

......

I certify that the information given above is correct.

Name:………………………………...... Signature:……………………Date:……………………….

(Official stamp)

Position/Designation…………………………………………………………………………………………

PART E: KALOLENI NG-CDF OFFICIAL USE ONLY

How much approved for disbursement……………………………………………………………………….

Date of Approval………………………………………………………………………………………………

Secretary’s Name……………………………………………….Signature………………….Date…………..

Official Stamp………………………………………………………………………………………………….

REQUISITION FORM

MINISTRY/DEPART…DEVOLUTION…AND PLANNING……………………………………

PROCURING ENTITY………………………………………………………

PROJECT NAME (GOODS, WORKS AND SERVICES)…………………….

FINANCIAL YEAR: ……………………………………………………………..

ITEM/NO / ITEM DESCRIPTION / QTY / UNIT PRICE / TOTAL
1 / Engine services (OIL) / 2 BY 4Lit
2 / Oil Filter / 1
3 / Fuel Filter(Diesel) / 1
4 / Air Cleaner / 1
5 / Gear Box Services (OIL) / 1BY 4Litrs
6 / Diff Services (OIL) / 1 BY4 Litrs
7 / Brake Pads/Front/Rear / 2 Sets.
8 / Pressure Plate / 1
9 / Clutch Plate / 1
10 / Release Bearing / 1
11 / Master Cylinder Kit / 2
12 / Wipper / 1
13 / Battery Chloride / 1
14 / Driving Member / 1
15 / Corn/corn Bearing / 1/2
16 / Gear Box Mounting ( upper) / 1
17 / Gear Box Mounting (Lower) / 1
18 / Fuel Geurge Service.
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QUARTER: ………………………………………………………………

REQUESTED BY: ………………………………………………………………..

AUTHORISED BY: …………………………………………………………………….

DATE AND STAMP: ......

THE EXCECUTIVE KNUT SECRETARY,

KALOLENI BRANCH.

DEAR SIR,

REF:WORKING OURS.

This is to put to your attention that our office working ours begins from 7 : 30 AM to 5 : 00 PM.

We kindly ague to bear with our rules so us to provide high security during this political season.

Yours truly

ANTHONY MUNYAO

Fund accountant Manager

KALOLENI NG-CDG.