FORM - VI





[Rules 10(2) and 27]



CITIZENSHIP ACT, 1955



Certified that whose particulars and photograph are furnished below, has 1[* * *] satisfied the conditions laid down in the Constitution of India/Citizenship Act, 1955 and is accordingly recognized as a citizen of India.

Particulars

Age …………………………………….

Height…………………………………….

Hair…………………………………….

Eyes…………………………………….

Special peculiarities and identification

marks…………………………………….

Name and surname…………………………………….

(in BLOCK LETTERS) …………………………………….

Date of birth…………………………………….

Nationality of origin…………………………………….

Surname and forenames of father

(in BLOCK LETTERS) …………………………………….

Occupation or profession…………………………………….

2[Present address]………………………………….

…………………………………….

Signature of grantee…………………

Date and place of issue Signature and designation of the issuing authority

1. Omitted by Notification No. GSR 383(E), dt. 4-6-1981.

2. Substituted by Notification No. GSR 383(E), dt. 4-6-1981.