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    Breat Ice

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    mmushi216

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    © All Rights Reserved
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    Breat Ice

    Uploaded by

    mmushi216
    2 views2 pages

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    Breat Ice

    Uploaded by

    mmushi216

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    © All Rights Reserved
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    THE UNITED REPUBLIC OF TANZANIA NO.

    240927K2142-B
    REGISTRATION INSOLVENCY AND TRUSTEESHIP AGENCY (RITA)
    APPLICATION FOR NEW BIRTH CERTIFICATE
    (BIRTHS AND DEATHS REGISTRATION ACT)
    (CAP 108)
    CHILD PERSONAL INFORMATION
    FIRST NAME BEATRICE MIDDLE NAME JOHN
    SURNAME MASULU OTHER NAMES --
    DATE OF BIRTH 25-OCT-2007 SEX FEMALE
    MOBILE NO 0767714064 EMAIL --
    OCCUPATION STUDENT NATIONALITY TANZANIA
    EDUCATION LEVEL SECONDARY EDUCATION PHYSICAL ADDRESS KALOLENI
    ENTRY NO --

    CHILD PLACE OF BIRTH CHILD PLACE OF DOMICILE


    COUNTRY OF BIRTH TANZANIA COUNTRY OF DOMICILE TANZANIA
    REGION OF BIRTH MANYARA REGION OF DOMICILE MANYARA
    DISTRICT OF BIRTH KITETO DISTRICT OF DOMICILE KITETO
    WARD OF BIRTH KIBAYA WARD OF DOMICILE KIBAYA
    STREET OF BIRTH KALOLENI STREET OF DOMICILE KALOLENI

    BIRTH INFORMATION
    PLACE OF BIRTH HEALTH FACILITY TYPE OF BIRTH SINGLE
    HOSPITAL NAME KIBAYA HOSPITAL BIRTH NOTIFICATION --
    WEIGHT AT BIRTH 0 PRESENT DURING DOCTOR
    DELIVERY

    MOTHER'S PERSONAL INFORMATION


    FIRST NAME ANNA MIDDLE NAME SEMKIWA
    SURNAME ISSA OTHER NAMES --
    DATE OF BIRTH 26-MAR-1971 SEX FEMALE
    MOBILE NO 0626179296 EMAIL --
    ID TYPE VOTER ID ID NO 100569916970
    OCCUPATION PEASANT(MKULIMA) NATIONALITY TANZANIA
    IDENTIFICATION TYPE VOTER ID IDENTIFICATION NO 100569916970
    NIN / NIDA 19710326275220000113 ENTRY NO --
    IS ALIVE YES PHYSICAL ADDRESS KALOLENI

    MOTHER'S PLACE OF BIRTH MOTHERS'S PLACE OF DOMICILE


    COUNTRY OF BIRTH TANZANIA COUNTRY OF DOMICILE TANZANIA
    STREET KALOLENI REGION OF DOMICILE MANYARA
    DISTRICT OF DOMICILE KITETO
    WARD OF DOMICILE KIBAYA

    MOTHER'S PREGNANCY INFORMATION


    NO OF PREGNANCY -- NO OF CHILDREN --
    NO OF SAFE DELIVERIES -- MONTH OF PREGNANCY --
    DEATHS BEFORE DELIVERY --
    FATHER'S PERSONAL INFORMATION
    FIRST NAME JOHN MIDDLE NAME MASALU
    SURNAME SAMSON OTHER NAMES --
    DATE OF BIRTH 27-SEP-1966 SEX MALE
    MOBILE NO 0626179296 EMAIL --
    ID TYPE NOT AVAILABLE ID NO --
    OCCUPATION TRADER(MFANYABIASHARA) NATIONALITY TANZANIA
    NIN -- ENTRY NO --
    IS ALIVE YES PHYSICAL ADDRESS KALOLENI

    FATHER'S PLACE OF BIRTH FATHER'S PLACE OF DOMICILE


    COUNTRY OF BIRTH TANZANIA COUNTRY OF DOMICILE TANZANIA
    STREET KALOLENI REGION OF DOMICILE MANYARA
    DISTRICT OF DOMICILE KITETO
    WARD OF DOMICILE KIBAYA

    INFORMANT'S PERSONAL INFORMATION


    FIRST NAME ANNA MIDDLE NAME SEMKIWA
    SURNAME ISSA OTHER NAMES --
    DATE OF BIRTH 26-MAR-1971 SEX FEMALE
    MOBILE NO 0626179296 EMAIL --
    ID TYPE VOTER ID ID NO 100569916970
    OCCUPATION PEASANT(MKULIMA) NATIONALITY TANZANIA
    NIN 19710326275220000113 ENTRY NO --
    PHYSICAL ADDRESS KALOLENI

    INFORMANT'S PLACE OF BIRTH INFORMANT'S PLACE OF DOMICILE


    COUNTRY OF BIRTH TANZANIA COUNTRY OF DOMICILE TANZANIA
    STREET KALOLENI REGION OF DOMICILE MANYARA
    DISTRICT OF DOMICILE KITETO
    WARD OF DOMICILE KIBAYA

    KIAPO: NATHIBITISHA KUWA MAELEZO NILIYOTOA HAPO JUU NI SAHIHI KWA KADIRI YA UFAHAMU WANGU NA NINAVYOAMINI
    (ONYO: UNAKUMBUSHWA KWAMBA KIFUNGU CHA 29 (3) LA SHERIA YA KUANDIKISHA VIZAZI NA VIFO LIMEWEKA ADHABU KWA MAKOSA YA KUTOA TAARIFA ZA
    UONGO)

    SIGNATURE DATE OF APPLICATION SEPTEMBER 27, 2024

    TAARIFA ZA MSAJILI

    MIMI
    MSAJILI WA VIZAZI NA VIFO (W) NIMEPOKEA MAELEZO YA MWOMBAJI CHINI YA KIAPO KWA
    MAMLAKA NILIYOPEWA CHINI YA KIFUNGU CHA 20(2) SURA YA 108 LEO HII

    SAINI YA MSAJILI TAREHE YA USAILI

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