Form Dcs-5 - Citizenship And Enrolment Notice Of Renunciation Form - Department Of Community Services

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Date received:
TOQUAHT NATION
 Approved  Denied
Citizenship Act
Department of Community Services
Citizenship No. or Citizenship
Form DCS-5
and Enrolment No. (as
applicable):
CITIZENSHIP AND ENROLMENT
NOTICE OF RENUNCIATION FORM
(for Citizenship and Enrolment
Registrar use only)
A. PERSONAL INFORMATION
Full Name of individual whose Toquaht Citizenship or Enrolment under the Maa-nulth Treaty is being
renounced:
Full Name:
Citizenship Number:
Enrolment Number:
Full Name of Parents or Legal Guardian(s) if different from Parents: (where the individual whose Toquaht
Citizenship or Enrolment under the Maa-nulth Treaty is being renounced is a child or an adult for whom a
committee has been appointed under the Patients Property Act (British Columbia))
Parent/Legal Guardian 1:
Parent/Legal Guardian 2:
Address:
City:
Province/State:
Code:
Telephone Number:
E-mail Address:
B. RENUNCIATION
I HEREBY FREELY, WITHOUT THREAT, PROMISE OR COMPULSION, ABSOLUTELY AND
UNCONDITIONALLY RENOUNCE MY: (please check one)
Toquaht Citizenship
Enrolment under the Maa-nulth Treaty
Toquaht Citizenship and Enrolment under the Maa-nulth Treaty
00621240

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