FORM - XII APPLICATION BY A PERSON FOR A CERTIFICATE OF NATURALISATION
PART - I
[Rule 17(1)]
CITIZENSHIP ACT, 1955-SECTION 6(l)
1. Full name of applicant in country of origin (in BLOCK LETTERS)
.
If now commonly known by another name, enter such name here
.
Private address
.
Occupation
.
Business address
.
Place and date of birth
.
Nationality at birth
.
Present nationality, if different
.
State if single, married, widower, widow or divorced
.
2. Fathers full name in country of origin (in BLOCK LETTERS)
.
Present address (if living)
.
Present nationality (if dead, give nationality at time of death)
.
Mothers full name in country of origin in BLOCK LETTERS)
.
Present address (if living)
.
Present nationality (if dead give nationality at time of death)
.
3. 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 naturalisation.
.
4. Principal languages of India known and extent of knowledge thereof with evidence
.
5. Statement regarding residence:
(a) I have resided in India or been in the service of a Government in India or partly the one and partly the other, throughout the period of 12 months immediately preceding the date of this application
.
(b) During the 1[twelve] years immediately preceding the said period of twelve months. I have either resided in India or been in the service of a Government in India or partly the one and partly the other, for periods amounting in the aggregate to not less than 1[9] years
.
Details of such residence and / or service
From date
To date
Address and / or details of service under a Government in India
Year
Month
If this application is granted, my intention as to future residence, (and/or service under a Government in India) is as follows
6. Reasons for which applicant wishes to acquire Indian citizenship
7. Approximate date of any previous application for Naturalisation
8. (a) I have renounced/lost the citizenship of my country in accordance with the law therein in force in that behalf
(Here list the documents attached to prove the fact of such renunciation/loss)
or
or
(b) I undertake that I will renounce the citizenship of my country in accordance with the law in force in that behalf in the event of my application being sanctioned
9. If original name has been altered, give particulars
Date of alteration
Give particulars of any other name(s) used for private purposes
Give particulars of any other name(s) used for trading or business purposes
10. If nationality has changed since birth give circumstances of change
.
If now of no nationality, give circumstances in which the previous nationality was lost
.
Give details with dates of foreign countries visited during periods of residence shown in item 5
.
11. Give details of all proceedings of any kind (civil or criminal) taken against you in courts of law.
Nature
Date
Place
Result
12. Date of any composition made with creditors
Date of being adjudicated bankrupt
Date discharge from bankruptcy
Date
Place
13. If married, give date and place of marriage
..
Nationality
Husbands or wifes full name before marriage (in BLOCK LETTERS)
..
Date Place
If husband or wife is dead, give date and place of death
..
Date Place
If marriage dissolved give date and place
..
..
...
14. Give particulars of legitimate children
Full name of each child
Date of Birth
Place
Where now resident
15. If a woman who was an Indian citizen previous to her marriage, whether her husband has died or whether her marriage has been dissolved
..
16. Names and addresses of at least two persons whose affidavits testifying to the character of the applicant and the correctness of the statements made in this application are attached herewith
..
17. I, the undersigned, to whom the foregoing particulars relate, hereby apply to the Secretary of the Government of India in the Ministry of Home Affairs or the grant of a certificate of naturalisation by the Central Government.
Station
..
Date:
Signature
.
1. Substituted by Notification No. GSR 392(E), dt. 13-4-1987.
Affidavit to accompany the application for a certificate of naturalisation under the Citizenship Act, 1955
In the matter of the application
under the Citizenship Act, 1955,
I,
son of
.. residing at make oath and say
.. do solemnly and sincerely affirm that the statements contained in my application hereunto annexed are true to the best of my knowledge and belief.
If, at any time before a certificate is issued to me, the accuracy of any of the foregoing particulars is affected by an alteration in circumstances, I undertake to inform the Secretary to the Government of India in the Ministry of Home Affairs in writing forthwith.
Station:
..
Signature
Date:
This declaration must not be made before a person who is the solicitor or agent of the applicant.
Caution: -Section 17 of the Citizenship Act, 1955, provides that Any person who, for the purpose of procuring anything to be done or not to be done under this Act, knowingly makes any representation which is false in a material particular shall be punishable with imprisonment for a term which may extend to six months, or with fine, or with both.
Affidavits testifying to the character of the applicant and the correctness of the statements made in the application
(Vide Item 16)
In the matter of an application for a certificate of naturalisation under the Citizenship Act, 1955, made by
I,
.. aged
.. years, by occupation
. son of
..residing at
. make oath and say
. do solemnly and sincerely affirm that I am an Indian citizen otherwise than by naturalisation; that I am a householder; that I am not a solicitor or agent of
that I have personal knowledge of, and intimate acquaintance with, the said
. for
. years; that the statements contained in his/her application for naturalisation are true to the best of my knowledge and belief.
I supports application for naturalisation and I can vouch for his/her good character and loyalty.
Signature
Name (in BLOCK LETTERS)
.
Full postal address:
..
Date:
.
In the matter of an application for a certificate of naturalisation under the Citizenship Act, 1955, made by
I
aged
years, by occupation
.. son of
. residing at
.. make oath and say do solemnly and sincerely affirm that I am an Indian citizen otherwise than by naturalisaton; that I am a householder; that I am not a solicitor or agent of
. that I have personal knowledge of, and intimate acquaintance with, the said
for
years; that the statements contained in his/her application for nauralisation are true to the best of my knowledge and belief.
I support
s application for naturalisation and I can vouch for his/her good character and loyalty.
Date:
. Signature Name (in BLOCK LETTERS) Full postal
address
..
..............
.
Copies of two issues (in triplicate) of a newspaper or newspapers circulating in the district in which the applicant resides, each containing (clearly marked) an advertisement in the following form should accompany the application.
Notice is hereby given that
. of
is applying to the Secretary to the Government of India in the Ministry of Home Affairs for naturalisation, and that any person who knows any reason why naturalisation should not be granted should send a written signed statement of the facts to the said Secretary.
