Declaration Of Renunciation Of Indian Citizenship

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High Commission of India
Jeevan Bharati Building, Harambee Avenue
P.O. Box 30074-00100; Tel: 2222566/7; Fax: 316242
NAIROBI, KENYA
CITIZENSHIP ACT, 1955 SECTION-8
FORM -XVII
Declaration of Renunciation of Indian Citizenship under Section 8 of the Act made by a Citizen of India
who is also a Citizen or National of another country
(To be submitted in DUPLICATE)
I,
am of fully capacity and was born at
on
. I have/have not been married. I am a citizen/national
of
under the law of that country. I hereby renounce my citizenship 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.
Signature
Made & subscribed this
day of
before me.
(The applicant must sign this form before the officer at the office of the High Commission of India, Nairobi.)
PARTICULARS OF THE APPLICANT
Full Name: __________________________________________________________________________
Address: ____________________________________________________________________________
Passport No.
Date & Place of Issue
Profession
Nationality
Single/Married
Name of Father & Nationality
Name of Mother & Nationality
Name of Spouse & Nationality, if any
Name of Children/Nationality, if any
PARTICULARS OF THE OTHER INDIAN PASSPORT HOLDER
I,
, the undersigned, hereby state that I am an
Indian citizen otherwise than by naturalisation, that I am householder, that I am not the solicitor or agent
of
and that I vouch for the correctness of the statement
made by him/her above .
Date
________________ (Photocopy of my passport is enclosed herewith)
_________________
Signature
Full Name
Address
Passport No.
Date & Place of Issue
NOTE: Original Indian Passport will NOT be returned after renunciation of Indian citizenship. Applicants for renunciation of
Indian citizenship are advised to keep a photocopy of the passport before surrendering it for renunciation of Indian citizenship.

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