(See rule 21 (1) ) THE CITIZENSHIP ACT, 1955, SECTION 8 ...

FORM XVII(See rule 21 (1) )THE CITIZENSHIP ACT, 1955, SECTION 8DECLARATION OF RENUNCIATION OF CITIZENSHIP UNDER SECTION 8OF THE ACT MADE BY A CITIZEN OF INDIA WHO IS ALSO ACITIZEN OR NATIONAL OF ANOTHER COUNTRY1. I, …………………………………….., living at ……………………………………,am of full capacity and was born at………………………………………………………on …………………………………………………………………………………………2. I have/have not been married3. I am citizen/national of…………………….under the law of that country.4. I hereby renounce my citizenship of India.I,………………………………………..…………………………………dosolemnly and sincerely declare that the foregoing particulars stated in this declarationare true, and I make this solemn declaration conscientiously believing the same to betrue.Signature………………………Made and subscribed this ……………………… day of…………………………………20……………. before me.Signature……………………..Designation…………………..

ParticularsFull name……………………………………………………………………………..Address……………………………………………………………………………….Profession or occupation……………………………………………………………..Place and date of birth……………………………………………………………….(Second) Nationality…………………………………………………………………Single, married, etc………………………………………………………………….Name of wife or husband.……………………………………………...……………Name and nationalities of parents…………………………………………………..………………………………………………………………………………………Names and full particulars of children. if any………………………………………………………………………………………………………………………………I………………………………………………………… the undersigned, hereby state that I aman Indian citizen otherwise than by naturalization that I am householder: and that I am not thesolicitor or agent of…………………………………….. I vouch for the correctness ofstatements made by……………………..........................in his application for renunciation ofCitizenship.Date………………..Signature…………………………………Name( IN BLOCK LETTERS)………………………………………………………………...Full postal address........................................................................................................................…………………………………………………………………………………………………..* Signature and designation of the officer authorized under rule 28 of the Citizenship Rules,1956, before whom the registration, declaration or oath of allegiance is made or taken.