Form PC1
Form PC1
Form PC1
REPUBLIC OF KENYA
C.O/S.NO…………………………………………………………......
Police Case No. ………………………………………………….........…….
Date to Court………………………………………………………....….
Protection and Care No. ………………………………………………………….....
Child’s Particulars
Name of Child…………………………………………………………………………………………………………………..….
Apparent Age……………………………………. Gender…………………………………………… Nationality……….…….
County…………………………………Language(s) ………………………. Religion…………………. Disability…………….
Special needs (list any needs that the child may have)
……………………………………………………………………………………………………………………………………..
Parent(s)/Guardian(s) Particulars
Name 1. ………………………………………………………………………………………………………………………….
2. ………………………………………………………………………………………………………………………….
Telephone/mobile ………………………………………………………………………………………………………………..
Physical / Home Address………………………………………………………………………………………………………….
Postal Address…………………………..………………………………………………………………………………………….
Relationship with the child ……………………………………………………………………………………………………......
BRIEF FACTS
As being in need of Protection and care under section ……………………………of the Children Act No. 8 of 2001
Applicant…………………………………………………………………………………………………………………