FORM A1 KENYA COCONUT DEVELOPMENT AUTHORITY

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
……………………………..…
………………..
………………..………………...…
……………………………..…
………………..
………………..………………...…
……………………………..…
………………..
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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.