Renunciation Form Page 2
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1
23.
Profession or occupation
.
4. Place and date of birth
.
5. (Second) Nationality
.
6.
Single,
married, etc
.
7. Name of wife or husband
.
8. Names and nationalities of parents
.
9. 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 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
.
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