FORM - III





APPLICATION FOR THE REGISTRATION OF A MINOR CHILD



[Rule5]



CITIZENSHIP ACT, 1955-SECTION 5(l)(d)



1. Full name of the minor child.

(in BLOCK LETTERS)

If he/she has been known by another name, enter that name here.

Present address.

Place and date of birth

2. Father’s full name.

(in BLOCK LETTERS)

3. Mother’s full name.

(in BLOCK LETTERS)

** Grounds on which the minor’s parents claim Indian Citizenship.

4. Minor’s period of residence in India: -

With whom residing

From date:-

To date:-

Address:-

Application

I, ……………………………… am a citizen of India and a parent/guardian of to whom the foregoing particulars relate. I hereby apply on behalf of my/the child for his/her registration as a citizen of India.

Date: …………….. Signature of applicant……………….

I, the undersigned, hereby state that I am an Indian Citizen otherwise than by naturalisation; that I am a householder; and that I am not the solicitor or agent of…………………….. I vouch for the correctness of the statements made by in……………………….. his application for…………………

Date…………………….

Signature………………….

Name (in BLOCK LETTERS)

Full postal address…………………

.........................................................

Declaration

I, A-B, do solemnly and sincerely declare that the foregoing particulars stated in the application are true and I make this solemn declaration conscientiously believing the same to be true.

Date……………………..

Signature……… …………

Made and subscribed this day 19 before me.

Signature

*Designation

This form when completed should be forwarded in triplicate to the Chief Secretary to the Government of the State in which the applicant is resident.

*The designation of the officer signing should be written here in his hand.

**If a citizen of India by registration or naturalisation, please refer to the number and date of the certificate of registration or naturalisation, as the case may be.