Application form for obtaining Deemed Surrender Certificate

1 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.

2 Place Signature Date Please enclose following with this form : 1. Canadian Passport, attach a copy of its photo page and all pages with observation. 2. Copy of Canadian Citizenship Certificate (Oath Certificate with date of citizenship MMDDYYY). 3. Copy of the Record of Landing 4. Notarised Affidavit (Explaining the reason of not submitting the Indian passport) 5. Requisite Fee (To Be Paid To BLS International Services) Time taken: Issue of Deemed Surrender Certificate requires references to authorities in India and elsewhere and therefore a minimum processing time undefined.