Personal Details

First Name of Applicant

Second Name of Applicant

District

Market

Telephone

Postal Address

Your Email

Date of Application

Assessment of Premise by Kenya Seed Staff / Ministry of Agriculture

Date of Assessment:

Remarks

Please tick the checkbox if remarks approved of not approved:
ApprovedNot Approved

Name of Assessing Officer

Designation

KEPHIS Licence Fee

Has the applicant paid Kephis license fee?
PaidNot Paid

Receipt Number

Kenya Seed Stocklist Card Number

Stocklist Card Number