Appendix Xvii Form S-1 Certificate Of Registration Birth In A Country Outside Pakistan Of A Child Born To A Citizen Of Pakistan

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APPENDIX XVII
FORM S-1
Certificate of registration birth in a country outside Pakistan of a child born to a citizen of Pakistan
(Vide Rule 21 of the Pakistan Citizenship Rules)
WHEREAS
AB______________________________________________________________
has reported the birth of a child named ________________________________________ son/daughter of
__________________________________________________ alleging with respect to that child and
himself the particulars set out below. Now therefore in pursuance of Rule 21 of the Pakistan Citizenship
Rules, 1952 it is hereby certified that the birth of the said child has been registered for the purposes of the
Pakistan Citizenship Act and the Rules made thereunder.
In witness whereof I have hereto subscribed my name this day of ____________________________ 1999.
Signed _________________________
(Pakistan Representative in the country outside Pakistan)
PARTICULARS RELATING TO THE CHILD AND APPLICANT
Full name of the child ________________________________________________________________
Father’s name: ______________________________________________________________________
Address in Pakistan:
Address outside Pakistan:
…………………………………….
………………………………………
…………………………………….
………………………………………
…………………………………….
………………………………………
Date of birth of the child: _________________________
Place of birth: City____________________ State______________ Country___________
Mother’s name: __________________________________________________________
Address in Pakistan:
Address outside Pakistan:
…………………………………….
………………………………………
…………………………………….
………………………………………
…………………………………….
………………………………………
Name of the applicant: _____________________________________________________
Address in Pakistan:
Address outside Pakistan:
…………………………………….
………………………………………
…………………………………….
………………………………………
…………………………………….
………………………………………
Marks of identification of the child
Photograph
Of the child
Signed _________________________
(Pakistan Representative in the country outside Pakistan)

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