09 6=E ('66E: ) )'6=- '91 -6'6>6):?

1E"L':'60)9- '"6
("='P6E: 1, ) 6=E L'<- ) KE9?')
AFF$%A&$'
0 @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ @@@@@@@
. of 'ddress @@@@@@@@@@@@@@@@@@@ "ity@@@@@@@@@@@@
@@@@.. -tate@@@@@@@@@. ;ip @@@
do wish to make oath and state as follows:4
1. '(A' $ am a Kenyan "iti$en =older of Passport 9umber @@@@@@@@.. issued to
me on @@@.. 1ay of @@@@@@@ at 9airobi.
!. Explain how your passport got lost
#. '(A' $ reported the matter to @@@@@@@@@@@@@@@@@@.. Police -tation
and was issued with a police 'bstract form copy of which is attached herewith.
&. '(A' the said passport has not been traced to date and 0 3erily belie3e the same
is lost.
,. '(A' $ apply to be issued with a new passport to replace the lost one. 'ttached
herewith is a copy of the application for a new passport and the necessary fees.
.. '(A' $ undertake to return the said passport to the Kenya Bo3ernment in the
e3ent that the same is found. 0 further undertake to indemnify the Kenya
Bo3ernment from any claims arisin% from the said lost passport.
/. '(A' $ swear this affida3it in support of my application to be issued with a new
passport to replace the lost one.
2. '(A' what is deponed hereto is true to the best of my knowled%e and belief.
)*'A+$,-% this @@ day @@.. of )
)
-F*+- M- .
A )*'A+/ P0L$C .
NB: This affidavit must be signed by both the applicant and the notary.