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Sert name and address of declarant) am of full age and capacity and was born at (with Tehsil, District, State and Country) ______________________ on__________________. 2. I have/have not been married. 3. I have acquired US/Foreign nationality on _______________ and consequently have obtained US/Foreign passport no. : ______________ dated ________________. 4. I hereby renounce my citizenship of India 5. Father's Name ________________________________ 6. Applicant's Date of Birth: _________________.

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