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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