APPLICATION FOR ISSUE OF NATIONALITY CERTIFICATE. FORM NO. (See.Rule.4) APPLICATION FOR ISSUE OF A MISCELLANEOUS CERTIFICATES R.I.Office............................... 1. Name of the Applicant.:- 2. Fathers/Husband's Name:- 3. Address (a)Permanent. (b) Present. 4. Age.........Years. 5. Type of certificate is required: (Identity /Nativity/Legal heir caste/ Income/Resident/Nationality/Valuation/Solvency/Possession and any other Certificate) 6. Purpose for which the certificates required. 7. Particulars on the basis of which the certificate is required. 8. List of documents and affidavit ( where necessary) enclosed with the application. 9. DECLARATION. I,Sri /Kumari /Smt................................. Son /daughter /wife of Sri . . .................................. Resident of village..................... P.O..................P.S. .................... the District in ....................... do hereby declared that the information and particulars stated above are true to the best of my knowledge and belief and they are exhaustive and I have not suppressed any fact. Incase it is detected later on that any of the facts stated above are wrong or that have suppressed some materials. I shall be liable for prosecution under the relevant law. Place. Date. Signature of the applicant.
