| |
Photograph |
| |
| 1. Full name of the applicant: |
.................................... |
| If commonly known by another name, enter such name here: |
.................................... |
| 2. Present address : |
.................................... |
| |
.................................... |
| |
.................................... |
| 3. (a) Sex: |
.................................... |
| (b) Occupation: |
.................................... |
| (c) If in service, address of employer: |
.................................... |
| (d) Mark of identification: |
.................................... |
| 3A. [ Do you belong to one of the minority communities from Afghanistan, Bangladesh and Pakistan, namely, Hindus, Sikhs, Buddhists, Jains, Parsis and Christians? Yes/ No |
If, yes, please specify .........................] |
| 4. Place and date of birth: |
.................................... |
| 5. Nationality by birth: |
.................................... |
| 6. Present nationality, if different: |
.................................... |
| 7. (a) Marital Status: |
.................................... |
| (b) If married, give date and place of marriage and nationality of the spouse : |
.................................... |
| (c) Husband's or wife's name: |
.................................... |
|
8. Father's full name is................................................resident of...........................................and he was born at (with Tehsil, District, State and Country).......................on......................and is a citizen of................................................
|
|
9. Mother's full name is........................resident of..............................................and he was born at (with Tehsil, District, State and Country) .......................on......................and is a citizen of..............................on...............
|
| 10. Whether the applicant is a subject or citizen of any country where an Indian citizen is prevented by law or practice of that country from becoming a subject or citizen of that country by naturalization. : |
.................................... |
| 11. Principal languages ofIndiaknown and extent of knowledge thereof with evidence |
.................................... |
| 12. Details of residence inIndia: |
.................................... |
| (a) Date of entry inIndia:....................................... |
.................................... |
| (b) I have resided inIndiacontinuously for a period of twelve months immediately preceding the date of application. |
Yes/No |
| (c) During the fourteen years immediately preceding the said period of twelve months, I have resided inIndiafor a period amounting in the aggregate to not less than eleven years. |
Yes/No |
| Sl. No. |
Details with address of residence inIndiafor the last fourteen years |
From |
To |
YearsMonths |
| 1 |
2 |
3 |
4 |
5 |
| |
|
|
|
|
| 13. Reasons for which applicant wishes to acquire Indian citizenship: |
.................................... |
| |
.................................... |
| 14. Passport particulars: |
|
| (a)Country: |
.................................... |
| (b)Number: |
.................................... |
| 15.Visa valid up to: |
.................................... |
| 16. Details of family members who are staying inIndiawith the applicant: |
| Sl. No. |
Name |
Present Address |
Relationship |
Age |
| 1 |
2 |
3 |
4 |
5 |
| |
|
|
|
|
| 17. Details of criminal proceedings, if any: |
| Sl. No. |
Nature of the criminal proceedings |
Date and place of registering the case |
Present status of the case |
Judgment of the court |
| 1 |
2 |
3 |
4 |
5 |
| |
|
|
|
|