Declaration Of Renunciation Of Citizenship Of India On Acquisition Of Citizenship Of Another Country Form

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RENUNCIATION CERTIFICATE
DECLARATION OF RENUNCIATION OF CITIZENSHIP OF INDIA ON
ACQUISITION OF CITIZENSHIP OF ANOTHER COUNTRY
Important Note:
1. ‘Applicant Name’ in this Form must be entered as per the ‘Name’ in last held Indian Passport.
2. Entire Form along with the Surrender Certificate section must be filled by the Applicant.
3. This Form should NOT be Notarized.
1. I _____________________________________________________ (here insert name and address of
declarant) am of full age and capacity and was born at (with Tehsil, District, State and Country)
______________________ on __________________.
2. I have/have not been married.
Please Select ------>
3. I have acquired US/Foreign nationality on _______________ and consequently have obtained
US/Foreign passport no. : ______________ dated ________________.
4. I hereby renounce my citizenship of India and surrender my Indian Passport No: ______________
Date of Issue: ____________Place of Issue: _________________
5. Father’s Name: ______________________
6. Applicant's Date of Birth: ___________________________
7. Names and full particulars of my minor children, if any, who are/were Citizens of India
____________________________________________________________________________
I, ____________________________________________ do solemnly and sincerely declare that the
foregoing particulars stated in this declaration are true and I make this solemn declaration conscientiously
believing the same to be true.
Made and subscribed this __________ day of __________________
Phone No:
Name:
E-mail:
Signature:
US Address:
Surrender Certificate
Date: ____________
This is to certify that Mr./Ms. __________________________________ has renounced
his/her Indian
citizenship and acquired ___________________ (name of the country) Citizenship.
His/Her Indian Passport mentioned above has been cancelled and returned to the
passport holder.
Signature & stamp (Consulate Officer)

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