Revised in October, 2022

SHG NEW

MINISTRY OF LABOUR AND SOCIAL PROTECTION

STATE DEPARTMENT FOR SOCIAL SECURITY & PROTECTION
DIRECTORATE OF SOCIAL DEVELOPMENT

APPLICATION FORM FOR REGISTRATION OF SELF- HELP GROUPS AS PER THE

COMMUNITY GROUPS REGISTRATION ACT, No. 30 of 2022.
COUNTY CONSTITUENCY SUB-COUNTY WARD

1. Basic information of the Group

Name of Group ….…………...........……...........................................................................

Date of Registration…………………………………………………………..

Type of Group (Tick one)□Youth □Women □Men □Mixed □Persons with disabilities □Older
Persons □Community Project □Other, specify…………
Is the group a Special Interest Group? □ Yes □ No

Division..…………………………......................Location .............................................................. Sub-

Location………………………………Village/Estate……………………………………….…………..
Year of Formation…………..Postal Address…………..…..Physical Address/Landmark……………

Email……………………………………….……….. Mobile………………………………………………
Website (where applicable)……………………………………………………………………………………
a. Who mobilized your members to seek official registration (Tick)?
• □Self
• □Officer from Social Development Office

• □ Social Development Committee

• □ MDCAs , specify……………..

• □ CBO

• □ NGO

• □ FBO

• □ NGAO □ Others. Indicate………………………

 b. Official meetings:

Meeting Venue…………………..........…….... Meeting Day(s)……..…….............Time.....................

2. Membership of the Group

Female Male Intersex Total
Total Number of members at the
time of registration
Number of Persons with
Disabilities (PWDs)
Number of Youth (18-35 years)
Number of Older Persons (60+
years)

3. Office Bearers: -
Date elections were conducted:……………..................Method of voting:………………………………..
Elections Venue:……………………..Supervised By:…………………………………Title:…………………
Contact Address/Tel. No:…….…………………Confirmed by:………………………....……………………
Title:....…….……………. Contact Address/Tel. No:…….………………………………..

No Position Name of Person F M ID/No. Mobile/Email Signature

1. Chairperson

2. Secretary

3. Treasurer

4. V/Chairperson

5. V/Secretary
6. Committee
Member
7. Committee
Member
*Attach a separate list of committee members if they exceed seven (7)

4. Group Objectives

i. ..…………………………….....................................................................................................................................

ii. ………………………………...........................................................................................................................

iii. ………………………………………………………………………………………………………………..
5. Group Activities
a) Type of Activity(ies) - tick as appropriate

1. Business
2. Community project
3. Crop farming
4. Cultural/traditional activities
5. Environment Conservation
6. Financial services
7. Fishery
8. Health care
9. Livestock rearing
10. Poultry keeping
11. Skills development
12. Tourism
13. Youth empowerment
14. Merry-go-round
15. Table banking
16. Other(s)

b) Specify your main activity.

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

6. Future Plans/Activities (if any)

i. ……………………………......................................................................................................................

ii. .……………………………….... ………………………………………………………………………

iii. ………………………………...................................................................................................................

7. How does the Group intend to fund its Activities (Tick as appropriate) –

□Members Contributions □ Loans □ Donations □ Grants □ Others……………………......................

8. Applicants Signature

Position □ Chairperson □ Secretary □ Treasurer (all officials to sign)

Chairperson
Name……………………………………………… Telephone…………………………………………

Signature…………………………………………. Date……………………………………………….

Secretary
Name……………………………………………… Telephone…………………………………………

Signature…………………………………………. Date……………………………………………….

Treasurer
Name……………………………………………… Telephone……………………………………………

Signature…………………………………………. Date…………………………………………………
 FOR OFFICIAL USE
1. Recommended by

□Chief/ Assistant Chief (Mandatory)

Name……………...................................................................................................................................

Location/Sub-location…………………………… Date…………………………………………..….
Stamp……………………………… …………… Signature…………………………………………

□Relevant Technical Ministry/Department (where applicable )

Ministry/Department…………………………………………………………………………….……….

Name of Officer …………………………………………Title…………………………………………..

Signature………………………………Date………………….... Stamp……………….………..............

2. Approved and Registered by County Coordinator/ Sub-County Officer for

Social Development

Name……………....................................................... Title:……………………………………………….

Signature………………………Date………………………………………Stamp…………………..……..
REQUIREMENTS FOR THE REGISTRATION OF A GROUP
1. Name search

2. Minutes of the meeting seeking registration and showing elected officials MUST be attached to the
application forms.
3. List of All members duly signed with Name/Position/Mobile. No/ID No. and Signatures
MUST be attached to the application forms.
4. ID copies for all members.
5. Application Form MUST be accompanied by the Group Constitution.
6. Pay Approved Registration fee of Ksh.1,

000/= NOTE:

After Registration, the Group Must adhere to the following;

i. Renew the Certificate Annually after the first two years of registration.
ii. Submit Annual Progress Reports to the Director Social Development
iii. Allow accessibility of records to the Director Social Development upon request or when
demanded to do so.

Failure to adhere to the above requirements will result to Non-registration/Deregistration.