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 / TOTAL1 / 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.
19
20
QUARTER: ………………………………………………………………
REQUESTED BY: ………………………………………………………………..
AUTHORISED BY: …………………………………………………………………….
DATE AND STAMP: ......
T0
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.