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 ADOPTION BY ___________________________________________

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 of and 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, ________________________ THAT the applicant be authorised to adopt _______________________(the child). THAT the costs of this application be costs in the cause.
day of 2010.

2. 3.

DATED at Nairobi this

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.

REPUBLIC OF KENYA IN THE HIGH COURT OF KENYA AT NAIROBI ADOPTION CAUSE NO. OF 2010 IN THE MATTER OF THE CHILDREN ACT 2001 AND THE ADOPTION RULES AND IN THE MATTER OF ADOPTION OF ________________________ AND IN THE MATTER OF THE APPLICATION FOR ADOPTION BY __________________________________________

AFFIDAVIT I, ____________________, Advocate of Post Office Box Number _____________, Nairobi in the Republic of Kenya make oath and say as follows: 1. 2. 3. 4. THAT I have the conduct of this Cause on behalf of the Petitioner herein. THAT ............................................... has consented to act as Guardian Ad Litem if so appointed by this Honourable Court. THAT the said ................................................. is personally known to me and I believe her to be a fit and proper person to be appointed as Guardian Ad Litem. THAT I make this Affidavit in support of an application that the said may be appointed Guardian ad Litem of the above. ) ) ) ) ) ) ) ) ) )

SWORN by the said at Nairobi this BEFORE ME day of 2010

COMMISSIONER FOR OATHS

DRAWN AND FILED BY:-

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 0F 2001 AND THE ADOPTION RULES AND IN THE MATTER OF ADOPTION OF _________________________ AND IN THE MATTER OF THE APPLICATION FOR ADOPTION BY _______________________________________________ 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. Our full names are _______________________________(adoptive parents) Our occupations are Our dates of birth are.......................... and ................................ evidenced by our passports which are hereto attached and marked _________ respectively. We currently reside at....................................... We are of ...................... nationality and of.................. race .

2. 3. 4. 5. 6. . 7. 8. 9. 10. 11.

We have been married since ......................... and are the people to whom the attached evidence of marriage relates and marked ___________ Our marriage is not polygamous or such as may lawfully become polygamous. We have No biological child. We profess the Christian faith. The child is of Kenyan nationality and ............................... race.

12. 13.

The child was found by a police officer, taken to the welfare/ childrens home (story of child) The child was admitted at childrens Home/ Trust .as evidenced by the Committal Order attached hereto and marked and the Admittance Form attached hereto and marked . 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 .. 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. We have not made a previous application for an adoption order in respect of the same.

14.

15.

16.

DATED at Nairobi this

day of

2010.

____________________________ (adoptive parents) DRAWN AND FILED BY:-

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 ADOPTION RULES AND IN THE MATTER OF ADOPTION OF ______________________ AND IN THE MATTER OF THE APPLICATION FOR ADOPTION BY ___________________________________________________

AFFIDAVIT IN SUPPORT OF THE APPLICATION

We , _______________________ and _______________________ make oath and say as follows:1. 2. THAT we are the applicant herein. THAT we have lived with the child since she was . months old. Attached hereto 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. THAT we are married and have an approximated annual income of Kshs. .............. THAT the Statements in paragraphs, 1, 2, 3, 4, 5, 6, 7, 8, 9,10,11,12, 13, 14, 15 and 16 of our Statement herein dated day of 2010 are true. The facts 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. ) ) ) 2010) ) ) ) ) ) )

1. 2.

5.

SWORN by the said ___________________ at Nairobi this BEFORE ME COMMISSIONER FOR OATHS day of

DRAWN AND FILED BY:-

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 ADOPTION BY ______________________________________________________

CONSENT TO ACT AS GUARDIAN AD LITEM I, .................................... of Post Office Box Number ...................., Nairobi states: 1. 2. THAT I am a ..................... by profession. .

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. day of 2010.

DATED at Nairobi this

............................................................ DRAWN AND FILED BY:-

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 ADOPTION BY ___________________________________________________________

AFFIDAVIT OF FITNESS OF THE PROPOSED GUARDIAN AD 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 Guardian Ad 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 to matters 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.

SWORN by the said ................................................ at Nairobi this BEFORE ME day of 2010

COMMISSIONER FOR OATHS

DRAWN AND FILED BY:-

) ) ) ) ) ) ) ) ) )

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 ADOPTION BY ___________________________________________________________
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.

PART A PARTICULARS RELATING TO THE CHILD

a. b. c. d. e. f. g. Name of Child Address Date and Place of Birth Nationality Why the child is offered for adoption Has the child got the right or interest in property Has any insurance been effected in respect of the child P.O. Box ..................Nairobi. __________, _____________(district found) Kenyan Abandonment No

PARTB Particulars relating to childs parent or guardian

PARTC PARTICULARS RELATING TO ADOPTER a. b. c. d. e. Names Address Country Domiciled Dates of Birth Religion ___________ and_____________ P.O.Box Kenya Christian Nairobi, Kenya

f.
g. h.

Marital status

Married

Occupations Is it intended to apply for joint adoption Order i. Do the adopters have any children j. The adopters have an approximate annual income of Kshs. /k. There is no evidence of insanity TB 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 child been confirmed by inspection of certificate of birth 2. Has a representative of the case committee interviewed the adopter 3. Has a home of the adopter been inspected by the representative? Was it found satisfactory 4. Is the adopter and the members of her household persons 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 .. ..

PART E MEDICAL PARTICULARS OF THE CHILD 1)a) c) d) 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Date of birth of the child b) Weight at birth Present weight Was the mothers confinement normal or instrumental State of nutrition Has the child any infection of bones, muscles, or joints Are there any evidences of paralysis, TB, syphilis Has the child had fits Have there been any infections of the skin, eyes Has the child had any discharge from ears, or any serious ear trouble Are the nose and throat in healthy condition Are there any evidence of disease of heart, lungs, kidneys or liver Has the child normal control of bowels and bladder for her age Has the child had measles, chicken pox, whooping cough mumps or poliomyelitis? Has the child received the following immunisations:BCG, Triple, Tetanus toxoid, small pox, measles Is the childs mental and physical development normal for his age Is her behaviour, speech and articulation normal for her age __________ _______ About kg Unknown Excellent .. . .. . .

. ........

Yes Yes Yes

13. 14.

_____________________________ (GUARDIAN AD LITEM) Dated at Nairobi this day of 2010

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 ADOPTION BY
______________________________________________

STATUTORY REPORT OF THE GUARDIAN AD 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 Court made 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