Para.20 (2) Serial No: 0001 FORM A1 KENYA COCONUT DEVELOPMENT AUTHORITY APPLICATION FOR REGISTRATION OF COCONUT NURSERY (To be filled in Quadruplicate) PART 1 Full Name of applicant ………………………………….... ID No. /Reg. No. ………….…...... Address ……………………………………………………………………………….…………. Tel. ………………………….… Fax ………..……….……. E-mail………….……………….. Province…………….… District……………….……….… Division ……..……..…………… Location……………………………………. Sub location…………………………………… 6. L.R. No. (Otherwise specify if no title deed)………………………………………………. 7. Altitude/AEZ ……………………………………………………………………………… 8. Water source: Rivers/Dam/Boreholes, others (specify) …………………………………… 9. Type of material to be produced: Coconut variety No. of Seedlings Source of Seed ……………………………..… ……………….. ………………..………………...… ……………………………..… ……………….. ………………..………………...… ……………………………..… ……………….. ………………..………………...… I confirm that I shall abide by the regulations and ensure that all seed material for planting has been inspected and approved by Kenya Coconut Development Authority inspectors. 1. 2. 3. 4. Applicants signature ………………………………… Date……………………………. FOR OFFICIAL USE ONLY PART II: Recommended/Not recommended………………………………….……………………………………. Remarks …………………………………………………………………………..……………………... Site inspected by ………………………………………………………………………………..……….. Inspector’s signature……………………….…………. Date ……..………………………………… PART III Approved/Not Approved ………………………………………………..…………………………….. Signed………………………………………………… Managing Director Kenya Coconut Development Authority ……………………….…………… Date Note: Application for registration of Coconut nursery should be sent to the Managing Director, Kenya Coconut Development Authority accompanied with Kshs.250.