Citizenship Affidavits — Master Form

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1. Affidavit — Schedule 1C 2. CAA Witness Affidavit 3. Self Declaration
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Common Notary, Date & Place used by all 3 docs

Applicant Identity used by Schedule 1C, Self Declaration, and named in CAA Witness

Bangladesh Origin Schedule 1C only

Passport Schedule 1C only — leave blank for dotted lines

Verification Schedule 1C only

Witness CAA Witness Affidavit only — this is a different person from the applicant

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Before the Notary Public at
AFFIDAVIT SCHEDULE 1C

I, , , Resident of , Dist: , Pin: , , do hereby solemnly declare and affirm as follows: -

(i) That I am a Bangladeshi national belonging to Hindu community in that country on the date of my entry into India and continue to belong to this community on the date of submission of this application and was residing at , Dist: . An Eligibility Certificate from a locally reputed community institution is enclosed.

(ii) That I am exempted by the Central Government under clause (c) of sub-section (2) of section 3 of the Passport (Entry into India) Act, 1920 and from the application of the provisions of the Foreigners Act, 1946 or any rule or order made thereunder in terms of Ministry of Home Affairs Notification No. G.S.R. 685(E) and Order No. G.S.R. 686(E) dated 07.09.2015 and Notification No. G.S.R. 702(E) and Order No. G.S.R. 703(E) dated 18.07.2016.

(iii) That I entered into India on

(iiiA) I am not in possession of a valid and/or expired passport(s) issued by the Government of Bangladesh.

I am in possession of a valid and/or expired passport(s) issued by the Government of Pakistan/Afghanistan/Bangladesh with the following details:-

Passport No. :

Date of issue:

Place of Issue:

Date of expiry:

I hereby agree to surrender my valid and/or expired Pakistani/Afghanistani/Bangladeshi passport to Senior Superintendent of Post or Superintendent of Post concerned within 15 days of approval of citizenship application.”

(iv) I am aware that it is an offence under the Citizenship Act, 1955 to make a false representation or concealment of any material fact and that if it is found later that wrong information has been furnished by me in this Affidavit and/ or in the Eligibility Certificate, I shall be deprived of my Indian citizenship abinitio.

VERIFICATION

Verified at this that the contents of the above affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein.

Date:
Deponent
Place:
Identified by me (Advocate)

Before the Notary Public at

Affidavit testifying the character of the applicant

(vide item 19)

In the matter of an application for a certificate of naturalization under the Citizenship Act, 1955, made by ,

I , aged years, by occupation , residing at , Dist: , Pin: , , make oath and do solemnly and sincerely affirm that I am an Indian citizen and I vouch application of ’s good character.

Date:
Place:
Signature
Name:
Full postal Address:
Identified by me (Advocate)

Before the Notary Public at

AFFIDAVIT

(To accompany the application for a certificate of naturalization under the Citizenship Act, 1955) In the matter of the application for a certificate of naturalization under the Citizenship Act, 1955.

I, , , residing at , Dist: , Pin: , , make oath and do solemnly and sincerely affirm that the statements contained in my application here unto 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 circumstances, I undertake to inform the Secretary to the Government of India in the Ministry of Home Affairs in writing forthwith.

Date:
Place:
Signature of Applicant
Identified by me (Advocate)