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Affidavit

IN THE MATTER OF OATHS AND STATUTORY DECLARATIONS ACT (CHAPTER 15 OF THE LAWS OF KENYA) AFFIDAVIT

I .................................................................................................................... .. of Address ....................................................... .. City .................................................. State ............................ Zip ........ . do wish co make oath and state as follows:-

  1. THAT I am a Kenyan Citizen Holder of Passport Number .......................... issued to me on ........... Day of ..................... at Nairobi.
  2. THAT on the ......... day of ....... e.g. while I had parked my cart at ........ I came back and noted that my car had been broken into na dmy Passport Number ........ among other personal items had been stolen from my bag which was in the car
    (N.B Change to give details on how you lost your passport)
  3. THAT I reported the matter to ........................................................ Police Station and was issued with a police Abstract form copy of which is attached herewith.
  4. THAT the said passport has not been traced to date and I verily believe the same Is lost.
  5. THAT I apply to be issued with a new passport to replace the lost one. Attached herewith is a copy of the application for a new passport and the necessary fees.
  6. THAT I undertake to return the said passport to the Kenya Government in the event that the same ili found. I further undertake to indemnify the Kenya Government from any claims arising from thoe said lost passport.
  7. THAT I swear this affidavit in support of my application to be issued with a new passport to replace the lost one.
  8. THAT what is deponed hereto is true to the best of my knowledge and belief.

NOTARISED this ...... day ........ of........

BEFORE ME

NOTARY PUBLIC