FORM - V





CERTIFICATE OF REGISTRATION



Rule [10]



No………………………………



This is to certify that the person whose particulars are given below has been registered as a citizen of India under the provisions of section 5(I)(a)/(d) of the Citizenship Act, 1955-

1. Name:

2. Name of father/mother or husband:

3. Place of birth:

4. Age

5. Present address:

6. Special peculiarities and identification marks:

7. Occupation:

Signature of grantee

Signature and designation of the issuing authority

Date and place of issue

1. Substituted by Notification No. GSR 567(E), dt. 1-4-1986.