FORM -XX CERTIFICATE OF REGISTRATION





[Rule 16 (B)]



No………………………………

This is to certify that the person whose particulars are given below has been registered as a citizen of India under the provisions of section 5(I)(a)/(d) of the Citizenship Act, 1955-

1. Name:

2. Name of father/mother or husband:

3. Date of birth:

4. Place of birth:

5. Nationality origin

6. Occupation:

7. Address:

8. Special peculiarities and identification marks:

Signature of grantee…………….. Signature and designation of the issuing authority

Date and place of issue……….