i (This Farms issued toe of charge andi NOT tr xe) REPUBLIC OF KENYA MINISTRY OF FINANCE x Tele on aise» PENSIONS DEPARTMENT El ences gpze .0.Boc2081 0209 ‘When ening pour wee NAIROBI Rett. 3 ATE: and dae MRMuRS, POBOX cope TOWN... EPENDANTS PENSION/WIDOW'S & vs PR ‘THE LATE MUMS, Please fada Guardianship cerifcte and a pay pont form enclosed fx Your completion and return ‘together wth te lowing {2 You identity card and tows ofthe two decane in Pat's I) nd ()hotocopy duly ceed by the ebie) (orignatend photocopies ofthe children’s bith cetifistes (Original eters from the Heads of school nsittions where the cildceno ‘ime edcaton. Leterme dl signed nd bear the orig scholars se (ra svorafdavt oc ets on xg tered fom your cd aea ci insoport of your ‘lationship wit the deceased Chie ltr mist bea righ cts stany ( affidavits must be original and stamped) (0 Wher he guardian i achild of the deceased pensioner an ciginal and photocopy ofthe tuardian's bith cerifeate must be provided ‘DAI forms ust bathe fll names and sgnatre ofthe claimant as they appear nthe national ‘enti card for ther to be secepted ‘Yours Faihfily,REPUBLIC OF KENYA CERTIFICATE OF GUARDIANSHIP (ORIGINAL To BE RENDER) PENSION FILE NO. TwEoREcToR ee PENSIONS DEPARTMENT Pogoxs0is1 NARI Dear SieMadaon (2) MMos ofP.O.Box ae, [Navona 1D No. Tel. No. and Email Address o semaly and sincerely declare that, ee 4am the guardian of the minor Children namely a ofthe ete Marrs OfP.0. Box ———_ "spect of whom his pesion fai and tht wl ais he bene sll fr the bene the ose iit. futher dete hat the cilities named ove re ave an at he deceased was my, (at Your reltonshp withthe decesed). $i SIGNATURE: DATE: Serene (© ATTESTATION GY MAGISTRATE OR COMMISSIONER OF OATHS) "cer taro he est of ay knows bee tate sipmtur shove hat of Maka nd that is her stamens in the cerifat ar comec, ee DATED THIS, DAY OF. 20 SIGNATURE OF ATTESTOR, TULL NAME OF ATTESTOR ADDRESS Ko ‘QUALIFICATIONDESIGNATION,el +. PENSION FILENO, RR ATHRECLARATION BY CLOSE BLOOD PATERNAL & MATERNAL RELATIVES OF THE ELIGIBLE CHILD/CHILDREN. (©) GRANDPARENTSIUNCLE/AUNT/BROTHERISISTERICOUSIN OF ‘THEIR FATHER. 1 of. Box National ID No, Tele, sand Email Adres to solemnty an sincerely declare tat Mira. {sth guar ofthe children ofte Late canis declaration conscientiously believing the sume tobe true snd in sccordance to the Oaths and Statutory Declaration Act, Cup 15. SIGNATURE OF DECLARANT. DATE Mo SRANDPARENIS/UNCLE/AUNT/BROTHER/SISTER/COUSIN ‘OF THER MOTHER. 1 of POBox, J a Telephone no. Email Adress do solemnly and sincerely declare that MMi s re the guardian ofthe chldeenof the Late Po Canis decleration coscentioulybeliving the same tobe true end in accordance to the Oaths and Statutory Declration Act, Cap 15. SIGNATURE OF DECLARANT. a (DECLARED BEFORE ME THIS DAY oF. 20, (MAGISTRATE OR COMMISSIONER FOR OATHS)AF ‘THE DIRECTOR OF PENSIONS, MINISTRY OF FINANCE, PENSIONS DEPARTMENT, Popox20i91 NAIROBL Dex Si, PAYMENT OF MONTHLY PENSION. L whose pension filo No... ‘mori peason tbe pad to teas Hom he ead of th oath of. {) Tommy bankaccout whose details relisted below- would He ay as fllows: NaMg@ OF BANE. ACOOUNT NO nm BRANCH. TOW. (Ni: PLEASE ATTACETA COPY OF YOUR BANK FLATE AND IDENTITY CARD “Yours fly,