THE UNITED REPUBLIC OF TANZANIA NO.

250607E2606-B
REGISTRATION INSOLVENCY AND TRUSTEESHIP AGENCY (RITA)
APPLICATION FOR OLD TO NEW BIRTH CERTIFICATE
(BIRTHS AND DEATHS REGISTRATION ACT)
(CAP 108)

CHILD PERSONAL INFORMATION

FIRST NAME REHEMA MIDDLE NAME BONIPHAS
LAST NAME LEMALI OTHER NAMES --
DATE OF BIRTH 2005-01-28 SEX FEMALE
MOBILE NO 0615233060 EMAIL RAYMOLLEL@[Link]
IDENTIFICATION TYPE NOT AVAILABLE IDENTIFICATION NO --
OCCUPATION STUDENT NATIONALITY TANZANIA
EDUCATION LEVEL SECONDARY EDUCATION PHYSICAL ADDRESS UBUNGO, DAR ES SALAAM
ENTRY NO L.385/2013

CHILD PLACE OF BIRTH CHILD PLACE OF DOMICILE

COUNTRY OF BIRTH TANZANIA COUNTRY OF DOMICILE TANZANIA
REGION OF BIRTH ARUSHA REGION OF DOMICILE DAR ES SALAAM
DISTRICT OF BIRTH ARUMERU DISTRICT OF DOMICILE UBUNGO
WARD OF BIRTH MBUGUNI WARD OF DOMICILE UBUNGO
STREET OF BIRTH SHAMBARAI STREET OF DOMICILE CHUO KIKUU

BIRTH INFORMATION
PLACE OF BIRTH HEALTH FACILITY TYPE OF BIRTH SINGLE
HOSPITAL NAME SHAMBARAI HOSPITAL BIRTH NOTIFICATION --
WEIGHT AT BIRTH (KG) -- PRESENT DURING DELIVERY --

MOTHER'S PERSONAL INFORMATION

FIRST NAME GRACE MIDDLE NAME ZAKAYO
SURNAME MOLLEL OTHER NAMES --
DATE OF BIRTH 1984-12-07 EMAIL GRACEMOLLEL@[Link]
MOBILE NO 0768395975 EDUCATION PRIMARY EDUCATION
IDENTIFICATION TYPE NOT AVAILABLE IDENTIFICATION NO NOT AVAILABLE
OCCUPATION PEASANT(MKULIMA) ENTRY NO --
IDENTIFICATION TYPE NOT AVAILABLE PHYSICAL ADDRESS ARUMERU, ARUSHA
NIN / NIDA -- IS ALIVE YES

MOTHER'S PLACE OF BIRTH MOTHER'S PLACE OF DOMICILE

COUNTRY OF BIRTH TANZANIA COUNTRY OF DOMICILE TANZANIA
NATIONALITY TANZANIA REGION OF DOMICILE ARUSHA
STREET SHAMBARAI DISTRICT OF DOMICILE ARUMERU
WARD OF DOMICILE MBUGUNI

MOTHER'S PREGNANCY INFORMATION

NO OF PREGNANCY -- NO OF CHILDREN --
NO OF SAFE DELIVERIES -- MONTH OF PREGNANCY --
DEATHS BEFORE DELIVERY --

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FATHER'S PERSONAL INFORMATION
FIRST NAME BONIPHAS MIDDLE NAME LEMALI
SURNAME MOLLEL OTHER NAMES --
DATE OF BIRTH 1977-04-14 SEX MALE
MOBILE NO 0768395975 EMAIL BONIPHASLEMALI@[Link]
IDENTIFICATION TYPE NOT AVAILABLE IDENTIFICATION NO --
OCCUPATION PEASANT(MKULIMA) EDUCATION PRIMARY EDUCATION
NIN -- ENTRY NO --
IS ALIVE YES PHYSICAL ADDRESS ARUMERU, ARUSHA

FATHER'S PLACE OF BIRTH FATHER'S PLACE OF DOMICILE

COUNTRY OF BIRTH TANZANIA COUNTRY OF DOMICILE TANZANIA
NATIONALITY TANZANIA REGION OF DOMICILE ARUSHA
PHYSICAL ADDRESS ARUMERU, ARUSHA DISTRICT OF DOMICILE ARUMERU
WARD OF DOMICILE MBUGUNI
STREET OF DOMICILE SHAMBARAI

INFORMANT'S PERSONAL INFORMATION

FIRST NAME REHEMA MIDDLE NAME BONIPHAS
SURNAME LEMALI OTHER NAMES --
DATE OF BIRTH 2005-01-28 SEX FEMALE
MOBILE NO 0615233060 EMAIL RAYMOLLEL@[Link]
IDENTIFICATION TYPE NOT AVAILABLE IDENTIFICATION NO --
OCCUPATION STUDENT EDUCATION SECONDARY EDUCATION
NIN -- ENTRY NO --
PHYSICAL ADDRESS UBUNGO, DAR ES SALAAM RELATIONSHIP TO CHILD SELF

INFORMANT'S PLACE OF BIRTH INFORMANT'S PLACE OF DOMICILE

COUNTRY OF BIRTH TANZANIA COUNTRY OF DOMICILE TANZANIA
NATIONALITY TANZANIA REGION OF DOMICILE DAR ES SALAAM
PHYSICAL ADDRESS UBUNGO, DAR ES SALAAM DISTRICT OF DOMICILE UBUNGO
WARD OF DOMICILE UBUNGO
STREET OF DOMICILE CHUO KIKUU

ACCOUNT DETAILS PAYMENT DETAILS

ACCOUNT EMAIL INFO@[Link] CONTROL NUMBER 991387715397
ACCOUNT MOBILE NO 0688718887 AMOUNT 7,000.00
PAYMENT STATUS PAID

KIAPO: NATHIBITISHA KUWA MAELEZO NILIYOTOA HAPO JUU NI SAHIHI KWA KADIRI YA UFAHAMU WANGU NA NINAVYOAMINI
(ONYO: UNAKUMBUSHWA KWAMBA KIFUNGU CHA 29 (3) LA SHERIA YA KUANDIKISHA VIZAZI NA VIFO LIMEWEKA ADHABU KWA MAKOSA YA
KUTOA TAARIFA ZA UONGO)

SIGNATURE DATE OF APPLICATION JUNE 07, 2025

TAARIFA ZA MSAJILI
MIMI
MSAJILI WA VIZAZI NA VIFO (W) NIMEPOKEA MAELEZO YA MWOMBAJI CHINI YA KIAPO KWA
MAMLAKA NILIYOPEWA CHINI YA KIFUNGU CHA 20(2) SURA YA 108 LEO HII

SAINI YA MSAJILI TAREHE YA USAILI

2/2 RITA - Births and Deaths Registra on System