Form Two - Statement For National Identity Card Replacement

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NATIONAL IDENTITY REGISTER
REGULATIONS, 2012
FORM TWO
(Regulation 10(2))
STATEMENT FOR NATIONAL IDENTITY CARD
REPLACEMENT
PLACE OF APPLICATION __________________________________________
DATE OF APPLICATION (DD/MM/YYYY) ____________________________
IDENTITY NUMBER (IF KNOWN) ___________________________________
SURNAME _______________________________________________________
FORENAME(S) ____________________________________________________
SEX __
PLACE OF BIRTH ___________________________
F
DATE OF BIRTH _________________________
POSTAL ADDRESS ________________________________________________
RESIDENTIAL ADDRESS ___________________________________________
_________________________________________________________________
(TICK AS APPLICABLE BELOW)
HAVE YOU EVER APPLIED FOR A CARD REPLACEMENT IN THE PAST?
YES _____ □
NO ______ □
IF “YES” STATE REASONS FOR CURRENT REPLACEMENT
1. LOST ___ □
2. DAMAGE ______________ □
3. DESTRUCTION __□
4. THEFT __ □
5. CHANGE OF SURNAME _ □
6. OTHER _________□

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