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RENUNCIATION CERTIFICATE

Govt. Form Reference # RENUNCIATION CERTIFICATERENUNCIATION OF CITIZENSHIP OF INDIA ON ACQUISITION OF CITIZENSHIP OF ANOTHER COUNTRYam of full age and capacity and was born , am3. I have acquired US / Foreign nationality onand consequently have obtained US / Foreign passport #:datedDate of hereby renounce my Citizenship Of India and surrender my Indian Passport Number :Place of 's 's Date of and full particulars of my minor children, if any, who are / were Citizens of IndiaDate of Issue Place of IssueName of Minor (s) Date of Birth Place of Issue US/Foreign Passport# I, do solemnly and sincerely declare that the foregoing particulars stated in this declaration are and I make this solemn declaration conscientiously believing the same to be true.

Govt. Form Reference # RENUNCIATION CERTIFICATE RENUNCIATION OF CITIZENSHIP OF INDIA ON ACQUISITION OF CITIZENSHIP OF ANOTHER COUNTRY 1. I, am of full age and capacity and was born at on

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