Application Form Name ofthe Person in fl EB Nare(s) of Father, Mother and SRS cae, {EMSs incr AEB ancinentoite Wo. OBES © Educational ‘wate SL Novof Father Mather and Spouse as recordeu nS Ne, column 4 Qecupatona OL * Qecupa . ( Geomtoey ORD" cece RE" can cesta ney tn Apnten 3 Fenecttoner + c Form will start with the + Catt § OF” naan on oe = : 5, feat tay oot secon ¢ ta See ” Er 4 Not in case of og eee QB" occupations Aco navi ‘enies vind more sae Bw oe, eee eae ncn nneens 8 omnes) fees Some? Sesto! Aease 8 femeacrgstone geno Fone sat erg Srey) Blows Eres, See, Baas fF etmes wens no? ® wote:Nationsiy recorded isa declared by the Applicant This doesnot confer any ighto Indian Citizenship. "the upaation of NRC, 1951 In Assam Is categ out under the provisions of The itzenship Act 1955 (Section 6A)and The Citizenship (Reglstration of CGitzenhip and issue of National gent Garde) Rule, 2003 Rule 4A and Scheu) ae amended in 2009 and 2070ember 40. BE Present Address sa {at famiy members have same adress ‘feinotot head ents some) [BBS uration of Stay (inyer aso thor 2018) Application Form QM Permanent Address. same a6 0. 68 writ ‘ame ‘Sthermse writ complete eaeress) QB Place of Birth ‘current Colour Phatogeaph wlth white bacgroune fo be pasted (otf be stapled)LEGACY DATA Pate ey nt ey Name of person with whom linkage claimed. EI)” nec 1951 Legacy Data Code. Relationship with the person x)" 5. Mo.ofsett-ttested documentary proof of lationship rom List 8 Pry Ec a 2 ch "Name of person with whom Tinkage claimed, Legacy Data Code Relationship withthe person Application Form REN ies ton ocens fom amg I saree QFEE"StNos of eligible documents from LIst (SL No.3 1). QTE Relationship wih the person om'*2 om” (Foliowing Documents shouldbe ‘sued ony upto fn March (dig except SEN. 15) cn Role) apo 1071 2, Passpat 9. Gowtesied leans! eniae 10. Gow sorvcotngloyment 19. Baard Unversty Eden ‘SUPPORTING DOCUMENTS # omst“oun- LIST 8 sEiitteo | Sere shoe Sash * rae documants wi ease onl if accompanid by ay oo ecumens Hon SL No.1 fn 1._*¥ On nese meres women igang tov one eno aahUpdation of National Register of oe ‘Application Form Member FEE) Particular of residence in place other than the state DUAL DETAILS OF FAMILY MEMBERS ‘of Assam upto 2th March (Misigh) 1971 Detals of Documt(s) submited for establishing ‘holt for nluslon n Updated NRC Incase of regular household he Application for inelision in NRC shal be made by the head of the Tamiy detaling partculars ofall family members. in case of insttuional nomes such as orphanages, old age nomes, asylums etc, the ‘esporsbilly of providing requisite detals ofthe Inmates shale wh the head of thetnattaions E The Application Form shall have particulars recorded fo alindvdual members of F the famly. Each Form has the provision of capturing deals wp 06s) members of tne family. Incase a family ras move tran 6 (x) members, adetonal Fore shal E bousea “The same order of Member Seri No witen on the fist page, Side A shall be {ofowed toughoutinal4 (our pages ofthe Form. The same salle maitained incase ofAcatonal Forms usedby lamiles havingmorethan6 (sx) members sidea Instuctions and codes for filing up @. 10, 0.28, 0:20, 0.26, 0.32,0.40,0.4080.4¢ {regen atthe daltom othe page, sides Individual members shall fish locaton particulars relate o (1) PresentAdcross {2} Permanent agaress and (8) Place of bith. Adsressee shal be waiten 38 per ‘mal indicated in the spaces marked nthe Applicaton Form. I the permanent dress is same uth the present address of individual momber hen cane ony same’ inthe space provid for 7. Place of bith shall be writen in ul by all members, Duration of slay he present adress in ars as on 1° Apa 2015 shal ‘Slsobe furishecunder@ 88, COny recent colour photograph ofthe size 2.5 om x 2.5m shallbe accepted. The photograph shoul be pasted properly using good quay gl. In any caso, saple Drpinehauldnolbe uses, ‘Any one of the three questions ©.9 oF @.10 oF .11 is sufclent. The parkculars| ‘entered inthis page shal be suppotes with documentary proof encosed withthe Form: Documents in suppor of @ 9a & Q.96,@.108 & C 10p and Q Ma & O11 shallbe soleced rom LISIA (any one's suffent laced athe botom ofthe page, ‘atic shoud be of any years uplo24” Maren 1971-andthe documents nsupportot 8.96 8.0.84, 0.100 80,104 and .14¢8 0.110 shal be elects rom Us (any ‘one i auficent) placed at the bottom of tha page. and sha also be accepted ‘seuedbefore aftr 24° Marcy 1971 ‘ideo {.122.nd a. 120 shall be applcabeto people who stayedin anyplace oer than {he state of Azsam upto 24th Marc (Monign), 1077. Pecans who are coginaly inhabitants of Assam and their chisren and descendants wo ae etizens of India saying in place other than the state of Assam upto 2th Moreh (Maeght). 107% may ‘ive therparteuars here. "ede tale lormatlon rowed he appar no. ofthe apliant| Istretothe best of my inoulege arabe inthe Applian Fm continued to tins Form mete Prong ny ase ieformaton woul sac pena ner the Corse 158 (For Office Use Only) ocation Particulars iia cea ape BARCODE Use only Arable numbersas indicated here [01 23 85 6 18