e-District - 0001 राज व वभाग, रा य राजधानी े , द ल सरकार Beneficiary REVENUE DEPARTMENT, GOVT. OF NCT OF DELHI colour Passport Size Photograph - Size – 5 x 4.5 (Cm.) आवेदन फाम रा यता माण प Or APPLICATION FORM – NATIONALITY CERTIFICATE 2 x 1.75 (Inch)
If applicant is minor (“minor” as per the provisions of the Indian Majority Act, 1875), parents documentary proofs has to be appended. Whereas ID proof, Citizenship Proof & Date of Birth Proof has to be of minor. If applicant is married women who not originally belonging to Delhi, but married to men who are resident of Delhi then she have to enclose her husband documentary proof whereas ID proof, Citizenship Proof & Date of Birth Proof has to be of married women.
Purpose to Obtain Certificate: ______
उ े य माणप ा त करने का ______1. Identity Proof of Applicant (Any One) UID (AADHAAR)/ National Population Register Number (NPR No.) (आधार मांक/रा य जनसं या रिज टर मांक) (Mandatory/अ नवाय )
Voter ID Card Passport (Valid) PAN Card Driving Licenses Ration Card with Photograph Service Identity Card (State/Central Government) with Photograph Freedom Fighter ID Card with Photograph Arm Licenses with Photograph Property Document with Photograph Pension Documents with Photograph SC/ST/OBC/Handicap Certificate with Photo Rashtriya Swasthya Bima Yojana smart card (MoL Scheme) Passbook with Photograph Job Card with Photograph (Issued under MNREGA) (Nationalized/Public Sector Banks/Post Office)
2. Name of Individual (In English) : ______(IN BLOCK LETTERS) : ______आवेदक का नाम ( ह द म )
3. Father’s / Husband’s Name (In English) : ______(IN BLOCK LETTERS) : ______ प ता/प त का नाम ( ह द म ) (Tick only in case of you are not originally belonging to Delhi, but married to men who is resident of the Delhi)
I am not originally belonging to Delhi, but married to ______, who is resident of the Delhi. ( Husband Name) Marriage Certificate No. : Issue Date DD MM YYYY
4. Residential Address (Permanent -In English) : ______(With Village/District/Pin code) ______ न वास का पता ( थायी - ह द म ) : ______(गॉ ं व/िज ला/ प न कोड स ह त) ______
APPLICATION FORM – NATIONALITY CERTIFICATE DELHI E-DISTRICT PROJECT (UNDER NEGP) Page 1
e-District - 0001
Permanent Residence Proof (Any One Is Mandatory): AADHAAR Card Issue Date DD MM YYYY
Voter Card Issue Date DD MM YYYY
Driving License Issue Date DD MM YYYY
Electricity Bill (CA No.) DISCOM Name ______
Passport (Valid) Expiry Date DD MM YYYY
Rent Agreement (Registered & Valid)
Period From Period To Total Period e-Stamp No. (DD/MM/YYYY) (DD/MM/YYYY) (Month/Year)
5. Residential Address (Present -In English) : ______(With Village/District/Pin code) ______ न वास का पता (वत मान - ह द म ) : ______(गॉ ं व/िज ला/ प न कोड स ह त) ______
Present Residence Proof (Any One Is Mandatory): AADHAAR Number Issue Date DD MM YYYY
Voter Card Issue Date DD MM YYYY
Driving License Issue Date DD MM YYYY
Electricity Bill (CA No.) DISCOM Name ______
Passport (Valid) Expiry Date DD MM YYYY
Rent Agreement (Registered & Valid) Period From Period To Total Period e-Stamp No. (DD/MM/YYYY) (DD/MM/YYYY) (Month/Year)
6. Contact Detail (Mobile No. is Mandatory) संपक ववरण (म बाईल नं अ नवाय है ) –
a. Mobile No. : b. e-Mail ID : ______@______
7. Gender ( लंग) : Male(पु ष) Female( ी) Transgender(अ य)
8. Period of Residence in India : ______Year(s) (वष ) ______Month(s)(माह) (भारत म न वास क अव ध ) 9 a. Birth Date ( ) : b. Birth Place ( ) : ज म द नांक DD MM YYYY ज म थान ______(Applicant/आवेदक) (Applicant/आवेदक)
APPLICATION FORM – NATIONALITY CERTIFICATE DELHI E-DISTRICT PROJECT (UNDER NEGP) Page 2
e-District - 0001 Date of Birth Proof of Applicant (Any One Is Mandatory):
Passport (Valid) Expiry Date DD MM YYYY
Aadhaar Number Issue Date DD MM YYYY
Driving License Issue Date DD MM YYYY
Birth Certificate Issue Date DD MM YYYY
10. Whether you are/ आप ह (Tick any one –if applicable / कोई एक टक कर - अगर लागू हो) –
Displace ( व था पत) Displace Date ( व थापन द नांक) : DD MM YYYY Displaced From ( व थापन थान) : ______Specify Place
Migrate ( थानांत र त)
Migration Date ( थानांतर द नांक) : DD MM YYYY Migrated From ( थानांतर थान) : ______Specify Place
Refugee (आ त) Registration Number : ______Registration Date : DD MM YYYY पंजीकरण सं या पंजीकरण द नांक Immigration from India to Pakistan (On or after 20/07/1948) आ वासन भारत से पा क तान के लए (को या 20/07/1948 के बाद)
Migration Date : DD MM YYYY Return Date to India : DD MM YYYY थानांतर द नांक भारत वापसी द नांक Authority which returned : ______ ा धकरण िजसके वारा लौटे
11. Citizenship Proof of Applicant (Any One Is Mandatory) : Passport (Valid) Expiry Date DD MM YYYY
Voter Card Issue Date DD MM YYYY
Driving License Issue Date DD MM YYYY
Birth Certificate Issue Date DD MM YYYY
Citizenship Certificate Issue Date DD MM YYYY
Naturalization Cert. Issue Date DD MM YYYY
NPR Number Issue Date DD MM YYYY
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e-District - 0001 12. Identity Proof of Parent (If applicant is Minor) (Any One Is Mandatory): UID (AADHAAR)/ National Population Register Number (NPR No.) (आधार मांक/रा य जनसं या रिज टर मांक) (Mandatory/अ नवाय )
Voter ID Card Passport (Valid) PAN Card Driving Licenses
Ration Card with Photograph Service Identity Card (State/Central Government) with Photograph Freedom Fighter ID Card with Photograph Arm Licenses with Photograph Property Document with Photograph Pension Documents with Photograph SC/ST/OBC/Handicap Certificate with Photo Rashtriya Swasthya Bima Yojana smart card (MoL Scheme) Passbook with Photograph Job Card with Photograph (Issued under MNREGA) (Nationalized/Public Sector Banks/Post Office)
13. Citizenship Proof of Parent (If applicant is Minor) (Any One Is Mandatory): Passport (Valid) Expiry Date DD MM YYYY
Voter Card Issue Date DD MM YYYY
Driving License Issue Date DD MM YYYY
Birth Certificate Issue Date DD MM YYYY
Citizenship Certificate Issue Date DD MM YYYY
Naturalization Cert. Issue Date DD MM YYYY
Nationality Certificate Issue Date DD MM YYYY
NPR Number Issue Date DD MM YYYY
Date ( द नांक) : DD MM 20YY Applicant Signature : (आवेदक के ह ता र) Place ( थान) : Eligibility Criteria The applicant shall be entitled for Nationality Certificate if he/she is- 1. Individual who is the citizen of India 2. A person who has a residence in Delhi 3. Women not originally belonging to Delhi, but married to men who is resident of the Delhi Facilitation Charges A facilitation charge of Rs. 100/- (per certificate per service request) is to be paid for issuance of Nationality certificate. Copy of issued Nationality certificate (With in a Validity Period) can be printed any number of time by citizen free of cost from website www.DelhieDistrict.gov.in or by any e-District kiosk throughout Delhi by paying printing charge of Rs. 10/- per copy. If Nationality Certificate Service is rejected then no printing charge will be charged for the copy of Rejection letter. Important Note If applicant is minor (“minor” as per the provisions of the Indian Majority Act, 1875), parents documentary proofs has to be appended. Whereas ID proof, Citizenship Proof & Date of Birth Proof has to be of minor. If applicant is married women who not originally belonging to Delhi, but married to men who are resident of Delhi then she have to enclose her husband documentary proof whereas ID proof, Citizenship Proof & Date of Birth Proof has to be of married women.
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