APPLICATION FOR THE GRANT OF NATIONALITY CERTIFICATE

1. Name of the applicant ...................................................................................................

(in BLOCK letters)
2. Father’s/Husband’s Name .............................................................................................
3. Address of the Applicant ..............................................................................................
4. Date and Place of Birth .................................................................................................
5. Period of residence in India ..........................................................................................
6. Place of birth of Mother & Father ................................................................................
7. Whether a displaced person ..........................................................................................
8. Date of Migration to India ............................................................................................
9. No. and date of refugee registration certificate ...........................................................
(Attested Copy should be attached)
10. In case of immigration from India to Pakistan on or after 20.7.1948 .......................
1. Date of such migration ............................................................................................
2. Date of return to India .............................................................................................
3. Authority to which returned ...................................................................................
11. Purpose for which certificate is required .....................................................................

Signature of Applicant ...................................

Full Name ........................................................
Address ............................................................

DECLARATION
I, … … … … … … … … … … … … … … .., do hereby solemnly declare that the facts men-
tioned in the application form are true and correct to the best of my knowledge and belief and
nothing has been concealed.

Signature of Applicant ...................................

Full Name ........................................................
Address ............................................................

NOTE: This declaration is to be signed by the Father/Guardian in case of the applicant is

minor.
 ATTESTATION

This is to certify that Shri/Smt/Km./Master … … … … … … … … … … … … … … … .

… … … … … … … … … … … … … … .. S/o/D/o/W/o … … … … … … … … … … … … … … … … …
… … … … … … … . R/o … … … … … … … … … … … … … … … … … … … .. is known to me for the
last … … … … … years and the facts given in application form are correct.

Signature of Applicant ...................................

Full Name ........................................................
Official Address .............................................
.........................................................................
(with Seal)

NOTE
The above attestation should be done by one of the following officers:-
1. Class-I Gazetted Officer of Govt. of NCT of Delhi or Central Government.
2. Police Officer not below the rank of the S.H.O.
3. Revenue officer not below the rank of Tehsildar.

The following documents are required for submission of the application form:-
1. Attested Photocopy of Birth Certificate.
2. Attested Photocopy of 10 th, 12 th Passed Certificate/any other Qualification certificate(s).
3. Attested photocopy of Ration Card (First Three Pages) or any other residence proof re-
garding residing in Delhi.
4. Attested Photocopy of passport (if any).
5. Any other relevant documents.