FORM X
Photo
Declaration of Renunciation of Citizenship under
Section 14-A of the Pakistan Citizenship Act, 1951
1. I
____________________________________________________________________________ of
_____________________________________________________________(address)
am
of
full
capacity and was born at _______________________________ on ______________________
2. I have / have not been married.
3. I am citizen / national of ______________________________ (name of the offering country) 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.
5. I do solemnly affirm that the foregoing particulars in this declaration are true to the best of my
knowledge and belief.
Attestation………………………………………………….
Signature ………………………………………………
Designation ………………………………………………..
Place ……………………………………………………..
Place and Date ……………………………………………
Date ………………………………………………………
PARTICULARS
1. Full Name: ________________________________________________________________________
2. Father’s Name: _____________________________________________________________________
3. Address: _______________________________________NICOP No:___________________________
4. Profession / Occupation: __________________________ Latest Pak Passport No________________
5. Place and Date of Birth:_______________________________________ Gender (M/F)____________
6. Second Nationality: _________________________________________________________________
7. Marital Status (Single / Married / Widowed / Divorced):____________________________________
8. Spouse Name:______________________________________________________________________
9. Name and Nationalities of Parents:_____________________________________________________
10. Name and Full particulars of Minor Children, if any, residing abroad, at the time of making
declaration:
S. No.
Name & Father Name
Relation
Date of Birth
(DD-MM-YYYY)
11. Address in Pakistan & Contact No. _____________________________________________________
_________________________________________________________________________________