FORM - IV





APPLICATION FOR THE REGISTRATION OF A MINOR CHILD



[Rule 6]



CITIZENSHIP ACT, 1955-SECTION 5(4)



1. Full name of the minor child in country of origin (in BLOCK LETTERS)……………

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

Present address…………………………….

Occupation …………………………….

Place and date of birth …………………………….

Nationality or citizenship at birth …………………………….

Present nationality if different …………………………….

If stateless, say how nationality was lost …………………………….

2. Father’s full name in his country or origin (in BLOCK LETTERS)……………….

Nationality or citizenship …………………………….

Country of origin…………………………….

Mother’s full name in her country of origin (in BLOCK LETTERS) ……….

Nationality or citizenship …………………………….

Country of origin…………………………….

3. Particulars of residence with address…………………………….

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The minor’s intentions with regard to future residence, if this application is granted, are as follows: -

4. Approximate date of any previous, application for naturalisation or registration Reference number, if known

Particulars of any change of nationality or of citizenship since birth

Nationality or citizenship acquired

Date acquired

Reasons for and the manner of change of nationality or citizenship ………………………..

5. Details of all proceedings of any kind (civil or criminal) taken against the minor in court of law ………………………………….

Nature

Date

Place

Result

6. The minor’s knowledge of a principal Indian language (to be mentioned) is slight /fair /good /excellent…………………………………….

7. Reasons for which the applicant desires to acquire citizenship of India …………………..

8. Names and particulars of near relations in India………………………….

Name

Present Address

Relationship

Age

APPLICATION



[Complete either (a) or (b) or (c) or (d) of this Portion of application and cross out whichever sections are inappropriate.

(a) I………………………….. the minor child to whom the foregoing particulars relate, hereby apply for registration as a citizen of India and attach the consent of my parent/ guardian to this application.

The parent who is citizen of India

(b) I……………………… am a citizen of India and a parent of…………. to whom the foregoing particulars relate. I hereby apply on behalf of my child or his/he registration as a citizen of India.

The parent who is not a citizen of India

(c) I…………………….. am a parent of………………….. to whom the foregoing particulars relate and am a national/citizen of……………………. the State of and I hereby apply on behalf of for his/her registration as a citizen of India.

The guardian

(d) I………………………………………… am the (sole) natural/appointed guardian of………………….. to whom the foregoing particulars relate, who has no living parent /whose parent or parents are living and resident in………………………. I am duly authorised by the court or by the minor child’s father (or mother in the event of his death whose consent is attached, and I hereby apply on behalf of for his/he registration as a citizen of India.

The reasons for this application are…………………. Date…………….. 19……….

Signature of applicant………

Declaration

I do solemnly and sincerely declare that the particulars stated in this application are true and I undertake to inform the Secretary immediately, if, before the registration now applied for is effected, the particulars given above require amendment, in consequence of any change in (a) my circumstances; (b) the circumstances of the minor child, and I make this solemn declaration conscientiously believing the same to be true.

Signature of applicant………

Minor child /Parent/Guardian

Made and subscribed this……………… day of………….. 19…………. before me.

…………………………………………………….

Signature and designation of the officer authorised under rule 28 of the Citizenship Rules, 1956 before whom the registration, declaration or oath of allegiance is made or taken

I, the undersigned, hereby state that I am a householder and an Indian citizen otherwise than by naturalisation. I am not the solicitor or agent of…………………………… and I vouch for his/her good character and loyalty.

I support this application from personal knowledge of and intimate acquaintance with the applicant for years.

Date…………………………. 19…………….

Signature…………

Name (in BLOCK LETTERS)

Full postal address ……………… …………………………………………….…………………….

2. I, the undersigned hereby state that I am a householder and an Indian citizen otherwise than by naturalisation. I am not the solicitor or agent of and vouch for his/her good character and loyalty. I support this application for personal knowledge of and intimate acquaintance with the applicant for years.

Date………………………. 19……………..

Signature…………………….

Name (in BLOCK LETTERS)

Full postal address

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