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Application form for obtaining Deemed Surrender Certificate

Application form for obtaining Deemed Surrender Certificate I Have Acquired Canadian Nationality on (Give Date) _____, therefore I hereby Renounce My Indian Citizenship. My Personal Particulars Are Given Below: Name Details of Indian Passport (if available): Passport Number :_____ Date of Issue :_____ Place of Issue :_____ Details Canadian / Foreign Passport, give details: Canadian Passport Number :_____ Date of Issue :_____ Place of Issue :_____ Phone Number :_____ E-mail Address :_____ Postal Address :_____ I may be issued a Deemed Surrender Certificate . Declaration I Solemnly Affirm That The Information Given Here Is Correct And Nothing Has Been Concealed And I Am Aware That It Is An Offence Under The Indian Passport Act 1967 To Knowingly Furnish False Information Or Suppress Material Information.

Application form for obtaining Deemed Surrender Certificate I Have Acquired Canadian Nationality on (Give Date) _____, therefore I hereby Renounce My Indian Citizenship. My Personal Particulars Are Given Below: Name Details of Indian Passport (if available): Passport Number :_____

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