Nativity Certificate Format and Sample of Application Form

Nativity Certificate is a document issued by the Government, wherein the appropriate authority certifies whether an applicant is of "Indian origin" or not.

An Indian origin person is a person who or whose either parent or grandparent or great grandparent was born and had lived in India as a native.

Nativity Certificates are issued by State Governments to the applicants, who lived in that particular state.

Application form formats for nativity certificates can be obtained from the concerned department of Statement Government, which is generally the Revenue department in the Sub-Collector's office.

Following formats are for your reference.

TEMPLATE of the Application

(Affix your passport size PHOTOGRAPH on the application form.)

APPLICATION FOR NATIVITY CERTIFICATE

Date of Application: ..................

To

(Title of Govt Authority)

(Department Name)

(Address)

Dear Sir/Madam,

I am hereby applying for the issue of Nativity Certificate for me, as I require it for some purpose. I kindly request your goodself to issue the same at the earliest possible.

Kindly find below the information as required in this regard:

1. Name of Applicant: ...............................                                  [Photograph]

2. Age, Date of Birth and Place of Birth: ...............................

3. Gender: ...............................

4. Father’s Name: ...............................

    Mother’s Name: ...............................

5. Present Nationality: ...............................

6. Present Address: ...............................

7. Phone Number: ...............................

Email id: ...............................

8. Place of permanent residence: ...............................

(of the applicant / father / paternal grandfather)

9. Place of ordinary residence proof: ...............................

(documents related to immovable property or birth certificates or ration card or school leaving certificate)

10. Aadhar Number: ...............................

11. Passport Particulars:

  (i) Passport Number: ...............................

  (ii) Place of issue: ...............................

  (iii) Date of issue: ...............................

  (iv) Valid until: ...............................

    (Signature)

(Name of the Applicant)

Verification/Declaration

I, (Name of the Applicant), son/daughter of (Name of the Father), born on (Date of birth), presently residing at (Address) and holding ............ nationality Passport No. .................... issued at (Place of Issue) on (Date of Issue) and valid until (Date of Expiry), do hereby solemnly affirm and declare that the information given by me in the application hereinabove are true and correct to the best of my knowledge and belief, and the documents appended thereto are genuine and the contents of the Documents are true and correct and that if these are found to be untrue and incorrect, I will be liable for prosecution for furnishing false and incorrect information and/or documents.

    (Signature)

(Name of the Applicant)

Date: ..............

TEMPLATE of the Certificate

(To be printed on the official letterhead.)

NATIVITY CERTIFICATE

This is to certify that the place of Birth of Mr./Mrs./Miss (Name of the Applicant) S/o / D/o / F/o / M/o / H/o / W/o / C/o (Name of the Person) is (Name of the Place) village/ town, (Name) Mandal, (Name) District of the State of (Name).

It is certified that Mr./Mrs./Miss (Name of the Applicant) is a native of (Name of the Place) village/ town, (Name) Mandal, (Name) District of the State of (Name).

Certified by:

(Signature) (Official seal)

Name: ...............................

Designation: .....................

Mandal: ............................

Date: ...................