FORM XVII
[See rule 21 (1)]
THE CITIZENSHIP ACT, 1955, SECTION 8
DECLARATION OF RENUNCIATION FO CITIZENSHIP
UNDER SECTION 8
OF THE ACT MADE BY A CITIZEN OF
CITIZEN OR NATIONAL OF ANOTHER COUNTRY
1. I, A-B, (here insert address of declaration) am of full capacity and was born at on
2. I have / have not been married.
3. I am citizen / national of under the law of that country.
4. I hereby renounce my citizenship of
I, A-B, 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 and subscribed this . day of 20 . before me.
Signature
Designation
Particulars
Full name
Address ..
Profession or occupation
Place and date of birth
(Second) Nationality ..
Single, married, etc.
Name of wife or husband
Names and nationalities of parents .
Names and full particulars of children, if any .
I, the undersigned, hereby state that I am an Indian citizen otherwise than by naturalization that I am householder; and that I am not the solicitor or agent of I vouch for the correctness of the statements made by in his application for .
Date .
Signature .
Name (IN BLOCK LETTERS) .................
..
Full Postal address
..
..
..
* Signature and designation of the officer authorized under rule 28 of the
Citizenship Rules, 1956, before whom the registration, declaration or oath
of allegiance is made or taken