SFC /STATE HOUSE DIVISION

(Restricted)

CIVILIAN DOCUMENTATION FORM.

1. Personal Particulars:
(i) Organization:
……………………………………………………………………………
(ii) Full names:
………………………………………………………………………………
(iii) Date of Birth:
……………………………………………………………………………
(iv) Gender: …………………………………………………………………………………
(v) Tribe: ……………………………………………………………………………………
(vi) Any Recognizable mark on your body:
………………………………………………
(vii) Personal Telephone contact:
…………………………………………………………...
(viii) Place of origin:
……………………………………………………………………………
(ix) Place of residence:
……………………………………………………………………....
(x) Is the LCI official known to you:
………………………………………………………...
(xi) Is the GISO known to you:
………………………………………………………………
(xii) Email Address/ Facebook Account:
……………………………………………………

2. Identification Documents:
a) National Identification Card (NIN Number):
………………………………………………
b) Electrical ID Number: …………………………………………………………………….
c) Driving Permit Number: …………………………………………………………………
d) Work Permit:…………………………………………………………………………………
e) Passport Number: ………………………………………………………………..
…………
f) Place of Issue: ………………………………………………………………………………
g) Date of Issue: ………………………………………………………………………………
h) Expiry Date: …………………………………………………………………………………
i) Bank Name: …………………………………………………………………………………
j) Bank Account:
………………………………………………………………………………..
k) Branch Name:
…………………………………………………………………………………
l) TIN Number:
…………………………………………………………………………………...
3. Assets Owned:
 ………………………………………………………………………………
 ………………………………………………………………………………
 ………………………………………………………………………………
 ………………………………………………………………………………
4. Family particulars:
(a) Father’s Particulars.
Name:…………………………………………………………………………………………
Village/zone:
………………………………………………………………………………….
Parish:……………………………………………………………………………………....
…
Sub county:……………………………………………………………………………..……
County:………………………………………………………………………………………..
District:……………………………………………………………………………………….
Nationality:
……………………………………………………………………………………
Tribe: …………………………………………………………………………………………
Place of work: ………………………………………………………………………………
Telephone contact:
…………………………………………………………………………
(b) Grandfather.
Name: ……………………………………………………………………………………….
Village/zone:…………………………………………………………………………….…..
Parish:
………………………………………………………………………………………...
Sub county: ………………………………………………………………………………….
County: …………………………………………………………………………………….…
District: ……………………………………………………………………………………….

(c) Grandmother:
Name: ……………………………………………………………………..
Village/zone: ………………………………………………………
Parish: ………………………………………………………………………………
Sub county: ………………………………………………………………………………
County: ………………………………………………………………………………

(d) Mother’s particulars:

Name: ………………………………………………………………………………
Village/zone: ………………………………………………………………………………
Parish: ………………………………………………………………………………
Sub county: ………………………………………………………………………………
County: ………………………………………………………………………………
District: ………………………………………………………………………………
Nationality: ………………………………………………………………………………
 Occupation: ………………………………………………………………………………
Place of work: ………………………………………………………………………………
Tel. contact: ………………………………………………………………………………
Grandfather: ………………………………………………………………………………
Grandmother: ………………………………………………………
Next of kin: ………………………………………………………………………………
Relationship: ………………………………………………………………………………
Place of residence: …………………………………………….
Tel. contact: …………………………………………………………

5. Marital status:
Married

Single
Name of spouse: ………………………………………………………
Home Address of Spouse: …………………………………………
Nationality: ……………………………………………………………
Occupation: …………………………………………………………….
Place of work: …………………………………………………………
Tel. Number: ……………………………………………………………
6. Names (age of children)
Name: Age: Telephone Contact:
……………………… …… …………………….
……………………… …… …………………….
……………………… …… …………………….
……………………… …… ……………………
……………………… …... ……………………
……………………… …… ……………………
7. Close Relatives:
Name: Relationship: Occupation: Residence: Tel.
Contact
……………… ………………… ……………. ………………… …………………

…………….. ……………….. …………… ……………… …………………

……………... ………………… …………… ……………… …………………

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

8. Close Associate/Best Friend:

Name: ……………………………………………………………
Occupation:………………………………………………………
Current place of residence: …………………………………..
Phone contact:…………………………………………………
Email address:…………………………………………………
Facebook account:…………………………………………….

9. Education Background:
Institute/sch. Of law.

Institute/ Location: Start Year: End Year: Qualification:

school

10.Other courses attained outside Formal Education

Institute/sch.

Institute/ Location: Start Year: End Year: Qualification:

school

11. Employment Record:

Employer & Designation Start Year End Year

Physical Address

Reasons why you left your previous

employment……………………………………………..
Have you ever served in a military organization? If yes
where?.........................................
Why did you
leave?.............................................................................................................
Have you ever gone outside Uganda? If yes
where?.........................................................
Reasons why you went
there…………………………………………………………………….
 Foreign languages spoken …………………………………..,
…………………………………
Have you ever been imprisoned?
Where?.........................................................................
Reason why you were imprisoned:………………………………………………………..
…….

12. Health:
Do you have any health problem? If yes, state the
problem………………………………….
How long have you had this
problem?.................................................................................
Do you require constant
medication?.................................................................................

DECLARATION:
I……………………………………………………………………………………………………………..
……………………………………………………………………………………………………………..
Signed by:
…………………………………
Commander Counter-Intelligence.

Signed by;
…………………………………..
Respondent.