56 CAP. 172 [Subsidiary] L.N. 101/2007, L.N. 185/2007. Form 15 [Rev. 2010 Immigration (r. 20) Serial No. ...................... SPECIAL PASS ............................................of ................................................., the holder of this pass is permitted to enter Kenya and remain therein for a period of .................. ...................... from the date of issue of this pass, for the purpose of ................. ............................................................................................................................ ............................................................................................................. This pass may be cancelled at any time and is issued subject to the following conditions: .......................................................................................... .............................................................................................................................. .............................................................................................................................. Date of issue................................... Receipt Number.............................. ........................................................ Principal Immigration Officer ___________ Form 16 (r. 27) APPLICATION FOR A RE-ENTRY PASS (All particulars to be in block capitals) I apply for a re-entry pass and declare that the following particulars are correct in every detail. Particulars 1. Full names of applicant: Mr./Mrs./Miss .................................................... .. .......................................................................................................................... 2. Address .......................................................................................................... 3. Particulars of the permit or pass issued to the applicant ............................. .. .......................................................................................................................... 4. Date of anticipated return to Kenya ............................................................. 5. Passport No. .................... Date and place of issue ...................................... Date.............................. ................................................... Signature of Applicant