REPUBLIC OF KENYA

IN THE TONONOKA CHILDREN’S COURT OF KENYA

AT MOMBASA

MISC. APPLICATION CAUSE NO. ……… OF 2018

IN THE MATTER OF: THE CHILDREN’S ACT 2000

IN THE MATTER OF: THE CUSTODY AND PARENTAL

RESPONSIBILITY OF …………

=BETWEEN=

xxxxxxxxxxxxx ….......................................................APPLICANT

=AND=

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ORIGINATING SUMMONS
(Under Section 4(2) 6(1), 81, 82, 83 and 94 of the Children’s Act of the Civil
Procedure Rules and Section 3A of the Civil Procedure Act)

LET THE PARTY CONCERNED within Ten (10) says of service on them enter
appearance to the summon which is issued on the application of ….............of P.O
Box 95015- 80100 Mombasa for Orders:-

1. THAT the Applicant be authorized to have legal custody of …............

DATED at Mombasa this ………. day of ……… ………….………. 2019.

m & CO.
(ADVOCATES FOR THE APPLICANT)

DRAWN & FILED BY:-

M & CO.
ADVOCATES
MOMBASA.

REPUBLIC OF KENYA
IN THE TONONOKA CHILDREN’S COURT OF KENYA
AT MOMBASA
MISC. APPLICATION CAUSE NO. ……… OF 2018
IN THE MATTER OF: THE CHILDREN’S ACT 2000

IN THE MATTER OF: THE CUSTODY AND PARENTAL

 =BETWEEN=
xxxxxxxxxxxx…...........................................................APPLICANT
=AND=
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2. kkkkkkkkkk

SUPPORTING AFFIDAVIT
I, …..................... of P. O. Box Number 95015- 80100, Mombasa in the Republic of Kenya
do hereby make oaths and state as follows;-

1. THAT I am the Applicant herein hence competent to swear this affidavit.

2. THAT I am a Kenya Citizen resident in Mombasa.
3. THAT I am married to …................ Annexed hereto is a copy of the Certificate of
Marriage to be marked as “BNA- 1”.

4. THAT …............... (minor) who is now aged Thirteen (13) years old is a niece of
my husband. Annexed is a copy of her Certificate of Birth No. 8508284 marked
as “BNA- 2”.

5. THAT the child was handed over to us when she was Six (6) years and she
knows me as her mother.

6. THAT I together with my husband desire to have legal custody and parental
responsibility over ….............

7. THAT I may relocate to the USA to work as a nurse and it is our desire that the
minor who is now part of my family relocates with us.

8. THAT I have made inquiries from the US Embassy and I have been advised that
I shall require an order granting me legal custody to enable me to travel with
her.

9. THAT I have sought and obtained the Consent of the father …................ and the
mother …................ which is annexed and marked as “BNA- 3”.

10. THAT I have also informed the chief of the legal adoption. Annexed here is a
copy of Chief’s letter marked as “BNA- 4”.

11. THAT it is in the best interest of the minor that he continues to live with the
family that she knows.

12. THAT I am also informed by Advocate that the best interests of the child is
paramount.

13. THAT I am ready and prepared to cater for all the minor’s needs whilst in my
custody and have all responsibilities pertaining to a parent in her regard.

14.THAT what is deponed to hereinabove is true to the best of my knowledge,

information and belief.
SWORN by the said }
…................................
……………………….
}
At Mombasa this………..…day}
Of………………………2019 }
}
BEFORE ME }
}
}
}
COMMISSIONER FOR OATHS

DRAWN & FILED BY: -

M& CO.
ADVOCATES
MOMBASA.

REPUBLIC OF KENYA
IN THE TONONOKA CHILDREN’S COURT OF KENYA
AT MOMBASA
MISC. APPLICATION CAUSE NO. ……… OF 2019
IN THE MATTER OF: THE CHILDREN’S ACT 2000
IN THE MATTER OF: THE CUSTODY AND PARENTAL
RESPONSIBILITY OF ………
=BETWEEN=
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=AND=
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2. llllllllllllllllllllllllllllllll

VERIFYING AFFIDAVIT
I, …................. of P. O. Box 9508715- 80100, Mombasa, Mombasa in the
Republic of Kenya do hereby make oath and state as follows:-
1. THAT I am the Applicant in this suit filed on my behalf by the firm of
M & CO. ADVOCATES, duly authorized and thus competent to swear this
affidavit.
2. THAT there has been no previous proceedings in any Court of law in
respect of the parties herein over the same subject minor herein.
3. THAT the facts stated herein in my statement attached herein are true and
correct to the best of my knowledge, information and belief.
SWORN by the said }
….............................
…………………….
At Mombasa this …….day
}
of…………………....2019 }
BEFORE ME }
}
}
}
COMMISSIONER FOR OATHS

DRAWN & FILED BY:-

M & CO.
ADVOCATES
MOMBASA.

REPUBLIC OF KENYA
IN THE TONONOKA CHILDREN’S COURT OF KENYA
AT MOMBASA
MISC. APPLICATION CAUSE NO. ……… OF 2019
IN THE MATTER OF: THE CHILDREN’S ACT 2000
IN THE MATTER OF: THE CUSTODY AND PARENTAL
RESPONSIBILITY OF ………
=BETWEEN=
kkkkkkkkkkkkkkkkkkk ….........................................................APPLICANT
=AND=
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2. lllllllllllllllllllllllllllllllllll

CONSENT TO LEGAL CUSTODY ORDER

WHEREAS an application is to be made by …....................and whereas
…..............(hereinabove called the child) is our daughter. We the undersigned
…...................and …...................... of Post Office Box 957615- 80100 Mombasa
being the father and mother of the minor states as follows;-
1. We understand that when an application for a Legal Custody Order is heard by
the Court. This document may be used as evidence of our Consent to the
making of the Order.
2. We Consent to the making of the Legal Custody Order.
Satisfied me that they fully understood the nature of the foregoing statement.
SWORN by the said }
1. …........................... ………………………
}
2. …............................ ………..…………….
At Mombasa this …….day }
of…………………....2019 }
BEFORE ME }
}
}
COMMISSIONER FOR OATHS
DRAWN & FILED BY:
-M & CO.
ADVOCATES
MOMBASA.