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REPUBLIC OF KENYA

IN THE HIGH COURT OF KENYA AT NAIROBI

ADOPTION CAUSE NO. OF 2010

IN THE MATTER OF THE CHILDREN ACT NO. 8 OF 2001 AND THE ADOPTION

RULES

AND IN THE MATTER OF ADOPTION OF ______________________________

AND

IN THE MATTER OF THE APPLICATION FOR ADOPTIONBY

___________________________________________

ORIGINATING SUMMONS(Under Part XII section 162 of the Child Act 2001 and Rule 4 of the Adoption Rules)

LET .............................................. of Post Office Box Number ............., Nairobi within ten (10)

days of service on her enter appearance to this summons which is issued on the application ofand

1 THAT this Honourable Court be pleased to appoint ...............................................

of Post Office Box Number ............., Nairobi, as guardian ad litem for the above named

child namely, ________________________

2. THAT the applicant be authorised to adopt _______________________(the child).

3. THAT the costs of this application be costs in the cause.

DATED at Nairobi this day of 2010.

ADVOCATE FOR THE PETITIONER

DRAWN AND FILED BY:-

NOTE: If the persons or any of them served does not enter appearance within the time above

mentioned the application will be heard and dealt with without further reference to

them or any of them unless the person is :

a. An adoption society which has made arrangements for the Adoption,

or

b. A person whose consent to the Adoption is required but has not been

given and in either of the latter cases notice of further proceedings in

the application will be required to be served in accordance with Rules

10A or 11 of the Adoption Rules.


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REPUBLIC OF KENYA



IN THE MATTER OF THE CHILDREN ACT 2001 AND THE ADOPTION RULES

AND IN THE MATTER OF ADOPTION OF ________________________

AND


__________________________________________

A F F I D A V I T

I, ____________________, Advocate of Post Office Box Number _____________,

Nairobi in the Republic of Kenya make oath and say as follows: -

1. THAT I have the conduct of this Cause on behalf of the Petitioner herein.

2. THAT ............................................... has consented to act as GuardianAd Litem if

so appointed by this Honourable Court.

3. THAT the said ................................................. is personally known to me and I

believe her to be a fit and proper person to be appointed as GuardianAd Litem.

4. THAT I make this Affidavit in support of an application that the saidmay be appointed Guardian ad Litem of the above.

SWORN by the said )

))

at Nairobi this day of 2010 )

)

BEFORE ME )

)

)

)

COMMISSIONER FOR OATHS )



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REPUBLIC OF KENYA



IN THE MATTER OF THE CHILDREN ACT NO. 8 0F 2001 AND THE ADOPTION

RULES

AND IN THE MATTER OF ADOPTION OF _________________________

AND


_______________________________________________

STATEMENT IN SUPPORT OF AN APPLICATION FOR ADOPTION ORDER(Under Rule 8 of the ADOPTION Rules)

1. We, the undersigned wish to adopt ____________ of (gender) born on____________ in _____________ District of the Republic of Kenya.

Annexed hereto and marked CJEN 1 is a copy of her Birth Certificate.

2. Our full names are_______________________________(adoptive parents)

3. Our occupations are

4. Our dates of birth are.......................... and ................................ evidenced by

our passports which are hereto attached and marked _________ respectively.

5. We currently reside at....................................... .

6. We are of ...................... nationality and of.................. race

.

7. We have been married since ......................... and are the people to whom the

attached evidence of marriage relates and marked___________

8. Our marriage is not polygamous or such as may lawfully become

polygamous.

9. We have Nobiological child.

10. We profess the Christian faith.

11. The child is of Kenyan nationality and ............................... race.


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12. The child was found by a police officer, taken to the welfare/ childrens

home (story of child)

13. The child was admitted at childrens Home/ Trust .as evidenced by the

Committal Order attached hereto and marked and the AdmittanceForm attached hereto and marked .

14. The child was declared free for adoption on .. by the Kenya

Childrens Home Adoption Society. The Certificate of Declaring a Child

Free for Adoption attached hereto and marked ..

15. We have not received or agreed to receive and no person has made or given

or agreed to make or given any payment or award in consideration of this

adoption.

16. We have not made a previous application for an adoption order in respect of

the same.


____________________________ (adoptive parents)



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REPUBLIC OF KENYA



IN THE MATTER OF THE CHILDREN ACT NO. 8 OF 2001 AND ADOPTION RULES

AND IN THE MATTER OF ADOPTION OF ______________________

AND


___________________________________________________

AFFIDAVIT IN SUPPORT OF THE APPLICATION

We ,_______________________and_______________________makeoath and say as

follows:-

1. THAT we are the applicant herein.

2. THAT we have lived with the child since she was . months old. Attachedhereto and marked . is a copy of the agreement between Kenya

Childrens Home Adoption Society and ourselves as Care Parents releasing the

child into our care.

1. THAT we are married and have an approximated annual income of Kshs. ..............

2. THAT the Statements inparagraphs, 1, 2, 3, 4, 5, 6, 7, 8, 9,10,11,12, 13, 14, 15 and16 of our Statement herein dated day of 2010 are

true.

5. Thefacts stated in paragraphs 1,2,3,4,5,6,7,8,9,10,11,12, 13, 14, 15 and 16 are true

to the best of our knowledge information and belief.

SWORNbythe said )

___________________ )

)at Nairobi this day of 2010)

)

BEFORE ME ))

)

COMMISSIONER FOR OATHS ))



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REPUBLIC OF KENYA




RULES

AND IN THE MATTER OF ADOPTION OF _________________________

AND


______________________________________________________

CONSENT TO ACT AS GUARDIANAD LITEM

I, .................................... of Post Office Box Number ....................,

Nairobi states:

1. THAT I am a ..................... by profession. .

2. THAT I understand the duties of a guardian ad litem under the Children Act

2001 and confirm that I am willing to be appointed guardian to the child.


............................................................



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REPUBLIC OF KENYA




RULES

AND IN THE MATTER OF ADOPTION OF _____________________________

AND


___________________________________________________________

AFFIDAVIT OF FITNESS OF THE PROPOSED

GUARDIANAD LITEM

I, ................................. an adult female of sound mind a resident of Nairobi, of Post Office

Box Number ................., Nairobi in the Republic of Kenya do hereby make oath and

solemnly state as follows: -

1. THAT I am the proposed GuardianAd Litem.

2. THAT I am a ........................... by profession.

3. THAT the applicants are close friends of many years.

4. THAT it is by being ......................... that I came to meet the applicants and got to

know them very well.

5. THAT I have therefore known the applicants prior to the bringing of this adoption

application and in that position I am suited and fit to act as Guardian Ad Litem.

6. THAT the applicants are morally fit and capable to take care of the child and they have

a sincere interest in the welfare of the child.

7. THAT I have no interests adverse to those of the child.

8. THAT what is deponed to herein is true and within my own knowledge save as tomatters deponed to on information sources and grounds whereof are disclosed which I

also believe to be true and I swear this Affidavit conscientiously and in accordance

with the provisions.


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SWORN by the said

................................................ )

)at Nairobi this day of 2010 )

)

BEFORE ME ))

)

)

COMMISSIONER FOR OATHS )

)DRAWN AND FILED BY:-


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REPUBLIC OF KENYA



IN THE MATTER OF THE CHILDREN ACT NO. 8 of 2001 AND THE ADOPTION

RULES

AND IN THE MATTER OF ADOPTION OF __________________________________

AND


___________________________________________________________

SUPPORT FOR PROPOSED ADOPTION OF .. BY

.

I, ..........................................................., do support the above mentioned proposed

adoption.

I also aver that the particulars given in parts A, B and C are true.

P A R T A

PARTICULARS RELATING TO THE CHILD

a. Name of Child

b. Address P.O. Box ..................Nairobi.

c. Date and Place of Birth __________, _____________(district found)d. Nationality Kenyan

e. Why the child is offered for Abandonment

adoptionf. Has the child got the right or

interest in property No

g. Has any insurance been effectedin respect of the child

P A R T B

Particulars relating to childs parentor guardian


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P A R T C

PARTICULARS RELATING TO ADOPTER

a. Names ___________ and_____________

b. Address P.O.Box Nairobi, Kenya

c. Country Domiciled Kenyad. Dates of Birth

e. Religion Christian

f. Marital status Marriedg. Occupations

h. Isit intended to apply for joint

adoption Orderi. Do the adopters have any children

j. The adopters have an approximateannual income of Kshs. /-

k. There is no evidence of insanityTB or other diseases in the adopters None

PART D

VERIFICATION OF APPLICATION

1a) Have the particulars given under A, B and C above

been verified so far as possible? ..b) Have the particulars of the birth of the childbeen confirmed by inspection of certificate of birth ..

2. Has a representative of the case committee interviewed

the adopter3. Has a home of the adopter been inspected by the

representative? Was it found satisfactory .

4. Is the adopter and the members of her householdpersons of good character? Have their references been

taken up

5a) Is the adopter of good health

b) Is this supported by medical evidence 6. Has the child been seen by the adopter

7. Has the child been accepted by the adopter with

a view to adoption


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PART E

MEDICAL PARTICULARS OF THE CHILD

1)a) Date of birth of the child __________

b) Weight at birth _______c) Present weight About kg

d) Was the mothers confinement

normal or instrumental Unknown

2. State of nutrition Excellent

3. Has the child any infection

of bones, muscles, or joints ..4. Are there any evidences of

paralysis, TB, syphilis .

5. Has the child had fits

6. Have there been any infectionsof the skin, eyes ..

7. Has the child had anydischarge from ears, or any serious

ear trouble .

8. Are the nose and throat in healthycondition .

9. Are there any evidence of disease

of heart, lungs, kidneys or liver

10. Has the child normal controlof bowels and bladder for her age .

11. Has the child had measles,

chicken pox, whooping coughmumps or poliomyelitis? ........

12. Has the child received the

following immunisations:-BCG, Triple, Tetanus toxoid, small

pox, measles Yes

13. Is the childs mental and physical

development normal for his age Yes14. Is her behaviour, speech and

articulation normal for her age Yes

_____________________________

(GUARDIANAD LITEM)

Dated at Nairobi this day of 2010


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REPUBLIC OF KENYA



IN THE MATTER OF THE CHILDREN ACT NO. 8 OF 2001 AND THEADOPTION RULES

AND IN THE MATTER OF ADOPTION OF ________________________

AND

IN THE MATTER OF THE APPLICATION FOR ADOPTIONBY______________________________________________

STATUTORY REPORT OF THE GUARDIANAD LITEM

I . of Post Office Box Number .., Nairobi having been

appointed to act as guardian ad litem in this case vide an order of this Honourable Courtmade by Honourable on the day of 2010 hereby submit my

Statutory Report pursuant to Rule 9 of the Adoption Rules.

1. APPLICANTS

2. REASONS FOR ADOPTION

3. CAPABILITIES OF THE APPLICANT TO RAISE AND EDUCATE THE CHILD

4. ATTITUDE TOWARD ADOPTION OF A FOREIGN CHILD

5.RECOMMENDATIONS

I HIGHLY RECOMMENDED THAT THIS ADOPTION BE APPROVED.

.

Dated at Nairobi this day of 2010

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