1. Name of Candidate : _______________________
2. Present Address
(i) Name of Jail : _______________________
(ii) Cell Number : _______________________
3. Political Party : _______________________ (List ONLY the Last Five parties in the Chronological Order)
4. Sex: [ ]
A – Male
B – Female
C – None of the Above
5. Nationality: [ ]
6. Reasons for leaving last party (circle one or more)
A – Defected
B – Expelled
C – Bought out
D – None of above
E – All of above
7. Reasons for contesting elections (circle one or more)
A – To make money
B – To escape court trial
C – To grossly misuse power
D – To serve the public
E – I have no clue (if you choose ‘D, attach Certificate of Sanity from a Recognized Government Psychiatrist)
8. How many years of public service experience do you possess?
A – 1-2 yrs
B – 2-6yrs
C – 6-15yrs
D – 15+yrs
9. Give details of any criminal cases pending against you (Use as many Additional Sheets as you want)
10. How many years have you spent in Jail? [ ] (Do not confuse with question 8)
A – 1-2 years
B – 2-6 years
C – 6-15 years
D – 15+years
11. Are you involved in any financial scams? [ ]
A – Why not
B – Of Course
C – Definitely
D – I deny it all
E – I see a foreign hand.
12. What is your Annual Corruption Income? [ ]
A – 100-500 Millions B – 500-1000 Millions
C – Overflow… (Convert all your $ earning from Hawala etc to Shilingi)
13. Do you have any developmental plans for Kenya in mind? [ ]
A – No
B – No
C – No
D – No
14. Describe your achievements in space provided: [_________]
