KHC/ND/STU/ *

Registration Form
(To be completed by Kenyan Students)


Subject

Category Type

Sur Name

Other Name *

Date of Birth *


Permanent Address in Kenya


Box No. *

Landline *

Fax No. *

Email *

Country *

Location *

Sub Location *

Village *


Travel Document


Passport Number *

Issued at Location *

Issued On Date *

Date Of Expiry *

Immigration File No. (R)


Academic


Date Of Arrival in India *

University

College

Course Of Study

Expected Date of Graduation


Residential Address in India


Address

Landline No.

Email *


Grades obtained in KCSE:


A

B

C

D



Mean Grade

State Any Other Qualification

Previous Employment


Family Details & Address in Kenya


Name

Occupation

Box No

LandLine no

Fax No

Email

Photo upload

Passport upload

Birth Certificate upload

School Leaving upload

KCSE Certificate upload

Kenyan ID Card upload


Give Particulars Of Any Other Two Person Who May be Contacted in Case Of an Emergency:


Name

Relation

Contact Address

Landline

Cell No.

Fax No.

Email

Name

Relation

Contact Address

Landline

Cell No.

Fax No.

Email

Date

NOTES
(a) Affix Passport size photograph
(b) Attach Photostat copies of passport including the page, on which the visa is endorsed, birth certificate, school leaving certificate and KCSE certificate.
(c) Attach Photostat copy of Kenyan I.D. Card (both sides)
(d) This form should be up-date when changes occur in connection with the information Provided.
(e) Please note that it is mandatory for all Kenyan nationals to register with the Mission Upon arrival in India.