Kenya Subsidiary l,egislation, 20 I 5

Registering Officer'

s

declaration:

.........:.....
postal address.........
as an agent of......
I (full name)

.............

of

being duly appointed and authorized
(telephone operator), confirm that I have
inspected the identification documents presented by......
appearing in
person before me for registration of SIM-card Number...
... and verified, to the
best of my knowledge, that the identification document is representative of the said
person.

I

also confirm that
to me.

I

.. ...

...

have entered the correct information as per the documents provided

I have further taken copies of all relevant documents presented to me for the registration
of the stated SIM-card and annexed the documents to this Form.
Registration Officer's Full Name...
Regisffation Officer's National Identification Card Number.
Made on

the

......

...

.. . ..

...

..

.

...........,2015.
NGENE B. GITUKU,
Chairman,
Communications Authority of Kenya.

PRINTED AND PUBLISHED BY THE GOVERNMENT PRINTER, NAIROBI

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