Certificate Of Citizenship Sample

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					III.2. Forms and applications


Sample Application Form for the Granting of Citizenship of the Slovak Republic




                                                                  Ministry of Interior of the Slovak Republic
                                                                  Department of Citizenship
                                                                  Drieňová 22
                                                                  826 86 Bratislava


Subject:
Application for granting of citizenship of the Slovak Republic




Name and surname:.......................................................................……...............................................
Maiden surname:….................................................................…….....................................................
Birth Number …………....................................................……..........................................................
Date and place of birth:..........................................……….................................................................
Address of permanent residence: .......…............................................................................................
Address of residence in the Slovak Republic:.....................................................................................




I also include my minor children aged up to 14 years in my application:




I apply for citizenship of the Slovak Republic for the following reasons:




.........................................................                                ........................................................
               Date                                                                            Applicant' s signature




                                                                                                                                                    1
Sample Statutory Declaration



                                                               Statutory Declaration



The person signed below..............................................................................................................

Family/Maiden name..................................................................................................................

Born (date) ........…............................................... Place of birth …...........................................

Residence ......................................................................................................................................




I declare, upon my honour, that .......................................... ........................................................

 ......................................................................................................................................................

.......................................................................................................................................................

......................................................................................................................................................

.......................................................................................................................................................

.......................................................................................................................................................

.......................................................................................................................................................


I make this Statutory Declaration for the purpose of ...............................................................

.......................................................................................................................................................




                                                                                ................................................................
                                                                                                      Signature




                                                                                                                                                          2
Questionnaire for the Application for granting of citizenship of the Slovak Republic available
at the web page: http://www.civil.gov.sk/p16/p16-02.shtm



District Office in ……………………………………………………..............................


                                         QUESTIONNAIRE
               For the application for granting of the citizenship of the Slovak Republic

Č.p:

I. 1. Applicant
    Name:
    Present surname:
   Maiden name:
    Title:
    Previous Surname:
    Date of birth:
   Place of birth:
   (municipality, district, state)
   * Birth identification number:
   (assigned in the SR)
   Address of permanent residence:
   (name, municipality, street, postal code, phone number)
   Address of temporary residence:
   (municipality, street, postal code)
    Telephone number:
    E-mail:
    Citizenship:
    Nationality:
   Employment:
   (name, municipality, street, postal code, employment position )
   Education:
   (highest education attained, school name: if the applicant wants to have academic title stated,
   s/he has to attach the diploma with the application)
   Knowledge of the official language:
    Marital status:
   Marriage entered into:
   (when and where)
    When and how marriage was terminated:




                                                                                                     3
2. Spouse
 Name:
 Present surname:
 Previous surname:
 Maiden name:
 Date and place of birth:
 Address of permanent residence:
 (municipality, street, postal code)
 Address of temporary residence:
 (municipality, street, postal code)
 Citizenship:
 Nationality:
 Employer:
 (name, municipality, street, postal code, employment position )
 Education:
 (highest education attained. name of school )


3. Children (adult children as well)
 Name and surname           Date and place of birth    Permanent residence           Citizenship




 4. Previous citizenship (or other citizenships), way of acquisition and way of establishing

 Previous applications for granting of citizenship of the Slovak Republic
 when:
 with what result:


 5. From what date residing in the territory of the SR (CSFR)
 Date from:
 Place (state all places of residence in the SR):
 Permitted residence:

 tolerated      from                    to
 provisional    from                    to                      purpose:
 permanent      from                    to                      purpose:



                                                                                               4
    Alien's residence card
    Number:                  Issued by:                     When:                    Validity:

    This residence was interrupted (when and staying where):

    Certificate of the Slovak living abroad (or Slovak expatriate card)
    Number:                                 From:

    Place of last permanent residence before coming to the SR (CSFR):

    Passport number:
    Valid (from-to):
    Issued by (state):


 6. If the applicant or his/her family member was criminally charged, when, where, and for
what reasons and with what results
II. Applicant's parents
                                  Father                                  Mother
    Name and surname:
    Permanent residence:
    Citizenship:
    Residence in the territory of the SR:

III. Applicant's siblings
  Name and surname            Permanent residence          Citizenship              Residence in the
                                                                                   territory of the SR




IV. Other data that the application wishes to state:




                                                                                                         5
        I declare that all the data I have stated in the questionnaire is true and that I have not withheld
any facts, which I confirm by attaching my signature in my own hand.

            I agree to having my personal data processed in connection with the application proceedings
for granting of citizenship of the Slovak Republic in the information systems of the District Office and
the Ministry of Interior when processing my application, in the scope provided by law.




                                 Place .......................................... date .......................................




…………………………………………………..                                                                    …………………………………………...
Signature of the officer accepting the application                                       Applicant's signature (if older than 14 years)




                                                                       ………………………………………………………….
                                                                      Signature of the legal representative, guardian, custodian
                                                              (if the applicant is a minor – under 18 years of age)



  Print of the District Office stamp




                                                                                                                                      6
Sample Application for establishing citizenship of the Slovak Republic and for the issue of the
Certificate of Citizenship of the Slovak Republic

                                                       District Office in _______________________

Subject:
APPLICATION FOR ESTABLISHING CITIZENSHIP OF THE SR AND THE ISSUE OF
THE CERTIFICATE OF CITIZENSHIP OF THE SR

   1. Applicant
Name (names) __________________________ Surname ___________________________________
Maiden name _________________________ Birth identification number ______________________
Date and place of birth _______________________________________________________________
Place and state of birth _______________________________________________________________
Address and state of present permanent residence __________________________________________
Address of last residence in the Slovak Republic (CS Republic)_______________________________
__________________________________________________________________________________
__________________________________________________________________________________
Place of permanent residence in the former Czechoslovak Republic as of 1 January 1969 ________
__________________________________________________________________________________
All previous residences in the Czechoslovak Republic_______________________________________
__________________________________________________________________________________
Former domicile in the municipality ____________________________________________________
Nationality in the 1930, 1940, 1950 Population Census ____________________________________
Date of departure abroad ___________________________________________________________
Passport of the SR (or CSFR, CSSR, CSR) issued in (year) _________________________________
by ____________________________________ valid until ________________________________
Foreign state citizenship (all foreign state citizenships acquired – and how they were acquired)
__________________________________________________________________________________
__________________________________________________________________________________
I have / do not have citizenship of the USA – date of acquisition _________________________
Purpose for which the Certificate is issued _______________________________________________
Marital status______________________________________________________________________
Date and place of marriage entered into __________________________________________________
Date of termination of marriage _______________________________________________________
   2. Spouse          (to be filled in by all except singles)
Name and surname __________________________________________________________________
Maiden name ______________________________ Birth identification number ________________
Date, place and state of birth _________________________________________________________
Citizenship at the time of entry into marriage _____________________________________________



                                                                                                 7
Present citizenship _____________________________________________________________
Present permanent residence__________________________________________________________
Last permanent residence in the SR, or former Czechoslovak Republic_________________________
__________________________________________________________________________________
    3. Applicant's father         (state the data even if no longer alive)
Name and surname: _________________________________________________________________
Family    name ___________________________________________________________________
Date, place and state of birth: ________________________________________________________
Citizenship at the time of birth of the applicant ___________________________________________
Name, surname, date and place of birth of his father ______________________________________
Name, surname, date and place of birth of his mother ____________________________________
    4. Applicant's mother
Name and surname: _________________________________________________________________
Maiden name ______________________________________________________________________
Date, place and state of birth: ________________________________________________________
Citizenship at the time of birth of the applicant ___________________________________________
Name, surname, date and place of birth of her father _______________________________________
Name, surname, date and place of birth of her mother ______________________________________

Attachments:
       - identity document: passport / identity card
       - birth certificate,
       - marital status document: marriage certificate /valid judgement of divorce / death certificate of
            spouse
       Where appropriate, the applicant shall also submit other documents that may establish Czechoslovak
       citizenship and citizenship of the Slovak Republic:
       - birth certificates of parents
       - marriage certificates of parents
       - passport used by the applicant or his/her parents when travelling abroad
       - confirmation or certificate of Czechoslovak citizenship, domicile certificate
       - issued Certificate of Citizenship of the Slovak Republic
       - statutory declaration that the applicant has acquired Czech citizenship – to be submitted by those
            citizens who lived in the territory of the Czechoslovak Republic in 1969-1992
       - confirmation of nationality and other documents certifying the facts stated in the application

I honestly declare that I have not acquired citizenship of the Czech Republic (by choice in 1969, by award until
31 December 1992). In 1993 I have acquired citizenship of the Czech Republic on _____________ under the
Act No. ___________ § _______.
         I am aware of the criminal consequences in case I state false data.
         Instruction:
         We ask you to complete the form in full; regarding the data that do not apply to you, please state in
words either “I do not have”, “I have not acquired”, “he did not leave,”, “he was not born,” etc.


Date of submission of the application __________________________________________________


________________________________                                     ______________________________
      Officer's signature                                                  Applicant's signature


                                                                                                              8
Sample Request for the receipt confirming payment for public health insurance of the child
and the duration of the insurance coverage




            Name, surname, applicant's address of permanent residence (legal representative's)




                                                               Relevant Health Insurance Company Branch Office


Subject:
Request for receipt confirming the payment of public health insurance of the child/children and
the duration of his/her/their insurance coverage.


I request herewith from the Health Insurance Company ......................... to issue a health insurance
receipt confirming payment for the public health insurance and the duration of the insurance coverage
of my child /children:


        -     child' s name and surname: .............................................................................
        -     date and place of birth: ....……........................................................................
        -     birth identification number ....….......................................................................
        -     address of permanent residence: .......................................................................


I request separate receipts for each of my children.
The reason for my request is the need to submit a receipt confirming payment for the public health
insurance and the duration of the insurance coverage for each of my children with my application for
citizenship of the Slovak Republic.




Place ...................................…………. date .........………………………..............




                                                                                     ........................................................
                                                                                                  Applicant's signature
                                                                                                 (Legal representative)




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