Transcription of RENUNCIATION CERTIFICATE
1 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.
2 Made and subscribed this PODay of(Signature of the Applicant)Full Name of the ApplicantMobile NumberPhone NumberEmail AddressAddress in the USA4uSSeOEeS $eSUJfJcaUeDate:This is to certify that Mr. / Ms. has renounced his / her Indian citizenship and acquired United States Indian Passport mentioned above has been cancelled and returned to the Passport holder.(Signature and Stamp (Consulate Officer)Note: The applicant is advised to retain this document for life long to avail consular services in future.)
