I, , , Resident of Vill- , P.O.- , P.S.- , Dist.-, Pin- , , do hereby solemnly declare and affirm as follows:-
| (i) | That I am an Bangladeshi national belonging to Hindu community in that country on the date of my entry into India and continue to belong to this community on the date of submission of this application and was residing at VILL- , PO-, PS- DIST-, Bangladesh. An Eligibility Certificate from a locally reputed community institution is enclosed. |
| (ii) | That I am exempted by the Central Government under clause (c) of sub-section (2) of section 3 of the Passport (Entry into India) Act, 1920 and from the application of the provisions of the Foreigners Act, 1946 or any rule or order made thereunder in terms of Ministry of Home Affairs Notification No. G.S.R. 685 (E) and Order No. GS.R. 686 (E) dated 07.09.2015 and Notification No. G.S.R. 702 (E) and Order No. G.S.R. 703(E) dated 18.07.2016. |
| (iii) | That I entered into India on . |
| (iiiA) | I am not in possession of valid and/or expired passport(s) issued by the Government of Pakistan/Afghanistan/Bangladesh. |
| (iv) | I am aware that it is an offence under the Citizenship Act, 1955 to make a false representation or concealment of any material fact and that if it found later that wrong information has been furnished by me in this Affidavit and/or in the Eligibility Certificate, I shall be deprived of my Indian Citizenship ab initio. |
Verified at (Place) this that the contents of the above affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein.
I, , , Resident of Vill- , P.O.- , P.S.- , Dist.-, Pin- , , make oath and do solemnly and sincerely affirm that the statement contained in my application here unto annexed are true to the best of my knowledge and belief.
If, at any time before a certificate is issued to me, the accuracy of any of the foregoing particulars in affected by an alteration in circumstances, I undertake to inform the Secretary to the Government of India the Ministry Of Home Affairs in Writing forthwith.
In the matter of an application for a certificate of naturalization under the Citizenship Act, 1955, made by (Name of the applicant) I, , aged- years, by occupation-, Son of , residing at Vill- , P.O.- , P.S.- , Dist.-. make oath and do solemnly and sincerely affirm that I am an Indian citizen and I vouch application of (Name of the applicant) 'S good Character.