FORM I (See rule 3) The Citizenship Act, 1955 -section 5(1)(a) APPLICATION FOR REGISTRATION AS A CITIZEN OF INDIA UNDER SECTION 5(1)(a) OF THE ACT MADE BY A PERSON OF INDIAN ORIGIN Note: Please write/print in BLOCK LETTERS PART I PHOTOGRAPH 1. I, ................... (here mention name and complete address of applicant including street or lane or village or town, police station and State) of full age and capacity and was born at (with Tehsil, District and State)............................. ...........on........ 2. My father's full name is /was..............and he was born at .......... on........ 3. My mother's full name is /was ............. and she was born at .......... on......... 4. My wife's/husband's full name is/was .......... and he/she was born at.......on......... 5. Details of residence in India : (a) Date of entry in India .......... (b) I have resided in India throughout the period of 12 months immediately Yes/No preceding the date of application. (c) During the eight years immediately preceding the said period of twelve months, I have resided in India Yes/No for period amounting in the aggregate to not less than six years. 6. (a) Profession or occupation: ..................... Details with address of From To Years Months residence in India for the last nine years (b) If in service, address of employer: .................. 7. Passport particulars: a) Country: ............ b) Number: ............ c) Place and date of issue: ............ d) Valid up to: ............ 8. Particulars of visa: a) Number and date of visa: ........... b) Place of issue: ........... c) Name of issuing authority: ........... d) Valid up to: ........... 9. Details of family members who are staying in India with the applicant: S.No. Name Present Address Relationship Age PART II 10. 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.) 11. I have/have not previously applied for registration as a citizen of India and the application has/has not been rejected. 12. 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. 13.I, ................(here mention the 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:.......... Made and subscribed this ........day .......of ......20.....before me. *Signature......... *Designation........ 14.I, the undersigned, hereby state that I am an Indian citizen otherwise than by naturalization, that I am a householder, and that I am not the solicitor or agent of......I vouch for the correctness of the statement made by..........in his/her application for Indian citizenship. Signature........... Name ............. Full postal address.......... .................. Oath of Allegiance I, .................(here mention the name of the applicant) do solemnly affirm and swear in the name of God that I will bear true faith and allegiance to the Constitution of India as by law established and that I will faithfully observe the laws of India and fulfill my duties as a citizen of India. Signature......... Affirmed/Sworn and subscribed this........day of ..........20..........before me. *Signature.......... *Designation......... *Signature and designation of the officer authorized under rule 28 of the Citizenship Rules, 1956, before whom the registration, declaration or oath of allegiance is made or taken. (i.e. the Collector, Deputy Commissioner, District Magistrate) (This Form complete in all respects shall be submitted in triplicate to the Collector/Deputy Commissioner/District Magistrate within whose jurisdiction the applicant is ordinarily resident for transmission to the Central Government through the State Government or the Union territory Administration, as the case may be) DOCUMENTS TO BE ATTACHED WITH THE APPLICATION BY THE APPLICANT 1. A copy of the valid Foreign Passport. 2. A copy of the valid L.T.V/Residential Permit. 3. Evidence of the date of birth of the parents viz. a copy of the passport or birth certificate or domicile certificate issued by the competent authority clearly stating that he/she is a citizen of India. 4. A copy of Bank challan in original amounting to Rs.500/-deposited in the State Bank of India under Head No."0070-Other Administrative Services-Other Services-receipts under Citizenship Act.
