FORM - XXII APPLICATION BY A CITIZEN OF CANADA FOR REGISTRATION AS AN INDIAN CITIZEN
[Rule 16C]
CITIZENSHIP ACT, 1955 (57 OF 1955)-SECTION 5(l)(e)
[This form when completed should be submitted in triplicate to the Collector within whose jurisdiction the applicant is ordinarily resident for transmission to the Central Government through the State Government /Union Territory Administration, together with a fee of Rs. 15 (Rs. 24.00 if the application is submitted through an Indian Mission abroad) (by Treasury challan) payable on submission of an application.]
1. Full name of applicant in country of origin (in BLOCK LETTERS)
.
If now commonly known by another name, enter such name here
.
Private address
.
Occupation
.
Business address
Place and date of birth
.
Particulars of passport held
.
(a) Number
(b) Place and date of issue
.
(c)Name of issuing authority
.
2. If original name has been altered
Give particulars
.
Date of alteration
.
Give particulars of any other name(s) used for trading or business.
Give particulars of any other name(s) used for trading or business
.
3. Fathers full name in country of origin (in BLOCK LETTERS)
.
Present address (if living)
.
Present nationality (if dead, give nationality at time of death)
.
Mothers full name in country of origin in BLOCK LETTERS)
.
Present nationality (if dead give nationality at time of death)
.
4. If married, give the date and place of marriage
.
Husbands or wifes full name before marriage
(in BLOCK LETTERS) and present nationality
.
If husband or wife is dead, give the date and place of death,
.
If marriage has been dissolved, give the date and place
.
.
5. Give details of family members in India:-
Full name
Date and place of birth
Relationship
Nationality
Present address
6. Give details of family members in India: -
Full name
Date and place of birth
Relationship
Nationality
Present address
7. Principal languages of India known and extent of knowledge thereof with evidence (Certificate to be attached)
.
8. Statement regarding residence:-
a. I have resided in India or been in the service of a Government in India partly the one and partly the other, throughout the period of twelve months immediately preceding the date of this application, and
.
b. During the seven years immediately preceding the said period of twelve months. I have either resided in India or been in the service of a Government in India or partly the one and partly the other, for periods amounting in the aggregate to not less than four years as follows: -
.
Details of residence and / or service
From date
To date
Address and / or details of service under a Government
Years
Months
If this application is granted, my intention as to future residence (and/or service under a Government of India) is as follows
.
9. Description of immovable property and/ or business interest in India
.
10. Description of immovable property and/or business interests abroad
11. Reasons for which applicant wishes to acquire Indian citizenship
.
12. Approximate date, and particulars of any previous application for grant of Indian citizenship
13. Give details with dates of foreign countries visited during periods of residence shown in item 8 above
.
14. Give details all proceedings of any kind (civil or criminal) taken against you in the courts of law
Nature
Date
Place
Result
15. If a woman who was an Indian citizen previous to her marriage, whether her husband has died or whether her marriage has been dissolved
..
16. Names and addresses of at least two persons who stamped affidavits testifying to the character of the applicant and the correctness of the statements made in this application are attached herewith
(i)
.
(ii)
..
I, the undersigned, to whom the foregoing particulars relate, hereby apply to the Secretary of the Government of India in the Ministry of Home Affairs for my registration as a citizen of India under section 5(1)(e) of the Citizenship Act, 1955 (57 of 1955). I undertake to renounce my Canadian citizenship and to take the oath of allegiance in the form specified in Schedule II to the Citizenship Act, 1955 (57 of 1955) in the event of my application for registration as an Indian as an Indian citizen being accepted.
Station
..
Date:
Signature
.
Specimen of affidavit (on duly stamped paper; to accompany the application
for registration under section 5(1)(e) of the Citizenship
Act, 1955 (57 of 1955)
In the matter of application for registration under section 5(l)(e) of the Citizenship Act, 1955 (57 of 1955), I
. son of
.. residing at
made oath and say
Do solemnly and sincerely affirm
that the statements contained in my application hereinto annexed are true to the best of my knowledge and belief.
If at any time before a certificate is issued to me, the accuracy of any of the foregoing particulars is affected by an alteration in circumstance. I undertake to inform the Secretary to the Government of India in the Ministry of Home Affairs in writing forthwith.
Signature
.
Station
.
Date
..
This declaration must not be made before a person who is the solicitor or agent of the applicant.
[Caution: Section 17 of the Citizenship Act, 1955 (57 of 1955) provides that:
Any person who for the purpose of procuring anything to be done or not to be done under this Act, knowingly makes any representation which is false in a material particular shall be punishable with imprisonment for a term which may extend to six months, or with fine, or with both.]
Specimen of Affidavit (on duly stamped paper) testifying to the character of the applicant and the correctness of the statements made in the application
(Vide Item 16)
In the matter of an application for a certificate of registration under section 5(1)(e) of the Citizenship Act, 1955, (57 of 1955) made by
.
I,
. aged
. years, by occupation
. son of
.. residing at
.
made oath and say
Do solemnly and sincerely affirm that I am an Indian citizen otherwise than by naturalisation;
that I am a householder; that I am not a solicitor or agent of
.................................................... that I have personal knowledge of, and intimate acquaintance with, the said
. for
years; that the statements contained in his/her application for registration are true to the best of my knowledge and belief.
I supports
. application for naturalisation and I can vouch for his/her good character and loyalty.
Signature
Name (in BLOCK LETTERS)
.
Full postal address:
..
Date:
.
Note: Copies of two issues (in triplicate) of a newspaper or newspapers circulating in the district in which the applicant resides, each containing (clearly marked) an advertisement in the following form should accompany the application.
Notice is hereby given that
. of
a Canadian citizen, is applying to the Secretary to the Government of India in the Ministry of Home Affairs for his registration as an Indian citizen under section 5(1)(e) of the Citizenship Act, 1955 (57 of 1955) and that any person who knows any reason why the request for Indian citizenship should not be granted should send a written signed statement of the facts to the said Secretary so as to reach him within 21 days of the publication of this notice;
Specimen of Oath of Allegiance
[See Schedule II to the Citizenship Act, 1955 (57 of 1955)]
[To be taken by the applicant after his application for registration under section 5(l)(e) of the Citizenship Act, 1955 (57 of 1955) his been accepted by the Central Government, but before he is registered as an Indian citizen.]
I,
do solemnly affirm (or swear) that I will bear true faith and allegiance to the Constitution of India as by law established, and that I will faithfully observe the laws of India and fulfill my duties as a citizen of India.
Signature
..
Date
.
Affirmed /Sworn and subscribed this
. Day
of 19
.. before me.
*Signature
..
*Designation
..
Signature and designation of the officer authorised under rule 28 of the Citizenship Rules, 1956, before whom the registration, declaration or oath of allegiance is made or taken
