FORM XII (See rule 17 (1)) The Citizenship Act, 1955 - section 6(1) APPLICATION FOR NATURALIZATION AS A CITIZEN OF INDIA UNDER SECTION 6(1) OF THE ACT Note: Please write/print in BLOCK LETTERS PART I PHOTOGRAPH 1. Full name of the applicant in country of origin :----------------------------------------------------- If now commonly known by another name, enter such name here :-------- --------------------------------------------- 2. Present address :----------------------------------------------------- 3. (a) Profession or occupation :----------------------------------------------------- (b)If in service, address of employer :---------------------------------------------------- 4. Place and date of birth :----------------------------------------------------- 5. Nationality by birth :---------------------------------------------------- 6. Present nationality, if different :----------------------------------------------------- 7. (i) State whether single, married, widower, widow or divorced :---------------------------------------------------- (ii) If married, give date and place of marriage and nationality of the spouse :---------------------------------------------------- (iii) Husband's or wife's full name before marriage. :---------------------------------------------------- 8.(i) Father's full name in the country of origin:-------------------------------------------------- 9. (i) Mother's full name (ii) Present address (if living) :----------------------------------------------------- (iii) Present nationality (if dead, give nationality at the time of death) :----------------------------------------------------- (ii) Present address (if living) (iii) Present nationality (if dead, give nationality at time of death) 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 of India known and :------------------------------------------------- extent of knowledge thereof with evidence 12. Details of residence in India: (a) Date of entry in India :------------------------------------------------- (a) I have resided in India or been in the service of the Government in India or partly the one and partly the other throughout the period of twelve months immediately preceding the date of this application. (b) During the fourteen years immediately preceding the said period of twelve months, I have either resided in India or been in the service of the Government in India or partly the one and partly the other, for periods amounting in the aggregate to not less than eleven years. Yes/No Yes/No Details with address of From To Years Months residence in India for the last fourteen years 13. If this application is granted, my intention as to future residence, (and/or service under the Government in India) is as follows: (a) House No. : .............. (b) Street name : .............. (c) Name of village/town: .............. (d) District : .............. (e) State : .............. 14. Reasons for which applicant wishes to acquire Indian citizenship: .............. 15. Passport particulars: (a) Country: .............. (b) Number: .............. (c) Place and date of issue: .............. (d) Valid up to: .............. 16. Particulars of visa: (a) Number and date of visa: ............... (b) Place of issue: ............... (c) Name of issuing authority: ............... (d) Valid up to: .............. 17. Give particulars of children: Full name of child Date of birth Place of birth Present address 18. 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: ............... PART II 19. I have/have not previously renounced or been deprived of the citizenship of India. (If the applicant has renounced his or her Indian citizenship, here state the date on which the declaration of renunciation was made; or if he or she has been deprived of his or her citizenship, state the date on which and the authority by whom, the order of deprivation was made.) 20. I have/have not previously applied for naturalization as a citizen of India and the application has/has not been rejected. 21. I declare that my intention is to make India my permanent home and I undertake that I shall renounce the citizenship of my country in the event of my application being sanctioned. 22. I, ................(here mention name of the applicant) do solemnly and sincerely declare that the foregoing particulars, stated in this application are true, and I make this solemn declaration conscientiously believing the same to be true. Date: ...... Signature:.......... Affidavit to accompany the application for a certificate of naturalization under the Citizenship Act, 1955.* In the matter of the application for a certificate of naturalization under the Citizenship Act, 1955, I..............son of .......... residing at .................make oath and do solemnly and sincerely affirm that the statements contained in my application here unto 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. Signature ........ Station........ Date ....... * Affidavits to be attested by Notary/Oath Commissioner/Magistrate. 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 five years, or with fine, which may extend to fifty thousand years or with both." Affidavits testifying the character of the applicant and the correctness of the statements made in the application. (vide item 18) 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 do solemnly and sincerely affirm that I am an Indian citizen otherwise than by naturalization; 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 naturalization are true to the best of my knowledge and belief. I support ..............'s application for naturalization and I can vouch for his/her good character and loyalty. Date ........... Signature.......... Name ........... 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 naturalization and that any person who knows any reason why naturalization should not be granted should send a written signed statement of the facts to the said Secretary." DOCUMENTS TO BE ATTACHED WITH THE APPLICATION BY THE APPLICANT 1. A copy of valid ForeignPpassport. 2. A copy of valid and up to date LTV/Residential Permit along with copies of last 14 years LTV/R.P. 3. A copy of Bank challan in original amounting to Rs.1500/- deposited in the State Bank of India under Head No."0070-Other Administrative Services-Other Services-Receipts under Citizenship Act." 4. One affidavit from self (applicant) and two affidavits from two Indians testifying to the character of the applicant in the prescribed language available in the application form. 5. Two language Certificates certifying the applicant's knowledge in any one of the Indian languages specified in the Eighth Schedule of the Constitution. 6. Two newspaper (circulating in the district in which the applicant resides) cuttings of different dates or of different newspapers notifying his intention to apply for citizenship.";
