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REGISTRATION OF KENYA NATIONALS IN CANADA OR CUBA

Field marked * are mandatory

NOTE: This information will be kept entirely confidential for official use only

First Nameyour first name
Middle Nameyour first name
Last Nameyour middle name
PLACE & DATE OF BIRTH
Countyyour full name
Date of Birthyour year of birth
Nationality (Citizenship): Mark ‘X’ appropriately
Nationality (Citizenship): Mark ‘X’ appropriatelypick one!
PASSPORT INFORMATION
Passport NumberEnter your Passport Number
Date of Issue
Place of IssueEnter where you got your passport
Date of Arrival to Canada/Canada
Port of ArrivalWhere did you arrive in Canada?
MARITAL DETAILS
Mark ‘X’ appropriately:pick one!
Maiden name, if married woman:Enter Maiden Name
Is your spouse with you in Canada/Cuba?pick one!
If so state date of arrival in Canada/Cuba:
Spouses nationality (citizenship)your full name
Any children?pick one!
If answer is yes, list their names and indicate sex, date and place of birth:more details
0 /
Are your children living with you:pick one!
Immigration Status in Canada/Cubapick one!
Another reason for being in Canada/Cubamore details
0 /
If in Cuba or Canada, What is the extended length of stayWhat is the extended length of stay
Next of Kin to be contacted in case of emergency:
In Canadamore details
0 /
In Kenyamore details
0 /
Current mailing address:more details
0 /
By signing your name below, you must agree that
the information you've provided above is true.
Your Nameyour full name

I agree that the information provided above is accurate and true.

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Kenya High Commission
415 Laurier Avenue East
Ottawa, Ontario
K1N 6R4, CANADA