APPENDIX-XVIII
FORM-‘X’ (Vide Rule 19-A)
Declaration of Renunciation of Citizenship under Section 14-A of the Pakistan Citizenship Act 1951
EMBASSY OF PAKISTAN
OSLO (Norway)
Photo
1.
I____________________________________________________________of_________________
___________________________________________________________ (here write address of declarant in Norway)
am of full capacity and was born at__________________________________________________ on
________________________.
2.
Married
Un-Married
(Tick relevant box)
3.
I am citizen/national of Norway under the law of that country or hold valid document assuring me
of the grant of citizenship or nationality of that country upon renouncing citizenship of Pakistan.
4.
I hereby renounce my citizenship of Pakistan.
I do solemnly affirm that the foregoing particulars in this declaration are true to the best of my
knowledge and belief.
Attestation by the Embassy
Signature:__________________________
Place:_____________________________
Dated:_____________________________
Phone Home________________________
Mobile_____________________________
PARTICULARS
1.
Full Name:
2.
Name of Father & Nationality:
3.
Name of Mother & Nationality:
4.
Address in Norway:
5.
Profession:
6.
Place & Date of Birth:
7.
Second Nationality:
8.
Marital Status (Please Tick):
9.
Name of Wife/Husband:
10.
If your children already have
Norwegian
citizenship,
please
DO NOT enter their names in
Form-X. If UDI has offered citizenship
to children below 21 years, please
enter their names in their father’s
Renunciation Application along with
Original Offer letters in their names
from UDI. If father has already
acquired Norwegian citizenship then
the child must wait until 21 to submit
his/her own renunciation case.
Single/Married/Widower/Widow/Divorced
S.#
1
Names of Minor(s)/Children
2
3
4
5
11. Address in Pakistan:
PLEASE DO NOT WRITE ANYTHING BELOW THE LINE
Date of Birth
COMPUTER PROFORMA
(Please Fill in from items No.4 to 12 only)
LOCATION
SERIAL NO.
1. MINISTRY (Dealing with the case)__________________________________________
2. DEPARTMENT (-do-)____________________________________________________
3. SUBJECT OF THE CASE__Renunciation
of Pakistan Nationality____
4. FULL NAME _______________________________________________________________________
5. DATE OF BIRTH ______/______/______
DD
MM YY
6.
SEX (Male/Female)____________
7. FATHER’S/HUSBAND NAME_________________________________________________________
8. PROFESSION/DESIGNATION________________________________________________
9. PASSPORT NO._____________________ 10.
NATIONALITY____________________
11. PRESENT ADDRESS IN PAKISTAN____________________________________________
_______________________________________________________________________
12. PERMANENT ADDRESS ____________________________________________________________
_______________________________________________________________________
13. VISIT SPONSORED BY___________N.A.____________________________________________
14. PURPOSE OF VISIT/EXTENSION IN STAY___________N.A.______________________________
FOR THE USE OF CLEARING AGENCY
CLEARED/NOT CLEARED
C/N
CLEARING CRITERIA (R/G)
REFERENCE NO.________________________________________ DATED
NOTE
INSTRUCTIONS FOR FILLING THE PROFORMA
(a) The form should be filled in CAPITAL Letters.
(b) All the boxes (
) should be left blank.
(c) Maximum information should be provided in the items from 4 to 12.
(d) In case of foreigner his contact address in Pakistan be mentioned in item No.(11) and his address abroad be
mentioned in item No. (12) above.