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REGISTRATION OF KENYA NATIONALS IN CANADA

Field marked * are mandatory

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

PLACE & DATE OF BIRTH
Nationality (Citizenship): Mark ‘X’ appropriately
Nationality (Citizenship): Mark ‘X’ appropriatelypick one!
PASSPORT INFORMATION
MARITAL DETAILS
Mark ‘X’ appropriately:pick one!
Is your spouse with you in Canadapick one!
Any children?pick one!
Are your children living with you:pick one!
Immigration Status in Canadapick one!
Next of Kin to be contacted in case of emergency (Name, Address, Telephone, Email):
By signing your name below, you must agree that
the information you've provided above is true.

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