FORM K ‘B’
CRP 021
RG………
TS………
GENERAL STUDENTS INDEXING FORM
INDEXING FEES PAYABLE BY ALL MEDICAL LABORATORY SCIENCE STUDENTS
Registration of students by the board is mandatory and not optional. All institutions offering Medical Laboratory
Sciences Programme must register all students on admission to the college. The below fees structure is presented
for your easy perusal
Student’s Name………………………………………………………………………………………. ID Number….…………………………………
School No. …………………………College/Institution………..……………………………………………………………………………………..
COURSE
APPLICATION
FEES
INDEXING FEES
TOTAL
Pre-service
 Certificate
 Diploma
 Bsc
500.00
Non-refundable
2,000.00
2,500.00
In-Service
 Diploma
 Higher Diploma
 Degree
500.00
Non-refundable
1,000.00
1,500.00
TICK
APPROPRIATELY
The above fees are payable to The Kenya Medical Laboratory Technicians and Technologists Board through the
institution admitting students and not directly to the Board. In each instance students must fill in application
forms to be remitted to the Board by the institution with the accompanying fees. Application fees are nonrefundable while indexing fees will be refundable to applicants whom the board denies registration for legitimate
reasons. Where an applicant deliberately lies to the board/training institution, indexing fees will be forfeited and
appropriate disciplinary action including prosecution in a court of law may be preferred against such an applicant.
REGISTRAR………………………………………………………………
KMLTTBFORM B ‘A’
RG………
TS………
APPLICATION FOR INDEXING AS MEDICAL LABORATORY TECHNICIANS AND
TECHNOLOGISTS STUDENTS AT CERTIFICATE/ DIPLOMA/ HIGHER DIPLOMA AND
DEGREE IN MEDICAL LABORATORY SCIENCES LEVELS
PART 1
(To be filled in Block letters by applicant in his/her own handwriting).
1. Surname…………………………………………………………………………………………………………………………………………………
2. Other names…………………………………………………………………………………………………………………………………………
3. National ID/ Passport No………………………………..………………………………………………………………………………………
4. Current Address……………………………………………………………………………………………………………………………………
5. Permanent Address……………………………………………………………………………………………………………………………..
6. Telephone No……………………………………………………………Mobile No………………………………………………………….
7. Fax No……………………………………………………………………..…e-mail…………………………………………………………………
8. Date of Birth………………………………………….…Place…………………………………………………………………………………...
9. Nationality…………………………………………………………………………………………………………………………………………….
10. Name of college/ Institution……………..……………………………………………………………………………………………………
11. Date of Admission………………………………………………………………………………………………………………………………….
12. Course Admitted for……………………………………………………………………………………………………………………………….
13. College Admission No………………………………………………..…………………………………………………………………………..
14. Year of study………………………………………………………………………………………………………………………………………….
15. Attach Certified copies of Certificates……………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………........
16. Student’s signature………………………………………………..Date………………………………………………………………………
17. Declaration.
Competent authority includes Government Administrative Officer, Legal Officer, Religious Minister
etc. No photocopy of this application will be accepted.
(Please turn overleaf)
PART II
DECLARATION BY INSTITUTION PRESENTING THE STUDENT FOR INTERNSHIP.
To be filled in capital letters
1.
(Full Name)…….………………………………………………………………………………………………………………………………………………………
Of ………………………………………………………………………………………………………………………………………………………………………..
Do hereby without prejudice declare that to the best of my knowledge, that the information given herein by the
applicant is true and correct.
Signature………………………………………………………………………………………………………………………………………………………………
Official stamp
Designation……………………………………………………………………………………………………………………………………………………………
Designation………………………………………………………………………………………………………………………………………………………....
PART III
(FOR OFFICIAL USE ONLY)
Delete whichever is not applicable
Date of Application……………………………………………………. Application No………………………………………….………………
Date Application received…………………………………………….. Receipt No.……………………..……………………………………..
Approved/Not Approved……………………………………………………………………. Date………………………………………………….