TORONTO

Affix your photo

of size 50X50mm
Approx

OCI Registration Form

FORM XIX (See Rule 25B)
Application for registration as an Overseas Citizen of India under
section 7A of the Citizenship Act,1955

Signature >
CANT024B0N15

Personal Particulars (As in Passport)

1. Surname

LALVA

2. Given Name

FATMA ABDUL SAMAD

4. Sex

FEMALE

5. Date of Birth

02-OCT-1969

6. Country(Birth)

INDIA

7. State (Birth)

GUJARAT

8. Place of Birth

DIVA IND

9. Marital Status

MARRIED

10. Nationality

CANADA

11. Visible Distinguishing Mark

2015/ OCI/ 0009392

File Ref No : CANT024B0N15

3. Previous Name

NON

Family Details

12. Father Name

SULEMAN KASAM NANBAWA

13. Father Nationality

INDIA

14. Mother Name

ZUBEDA SULEMAN NANBAWA

15. Mother Nationality INDIA

16. Spouse Name

LALVA ABDUL SAMAD SULEMAN

17. Spouse Nationality INDIA

Passport Details

18. Passport No

QE520729

20. Place of Issue

KITCHENER

19. Date Of Issue

Occupation Details

21. Occupation

HOUSE WIFE

22. Employer Address

NA

Applicant's Contact Details

23. Present Address

39 WENDY COURT, CAMBRIDGE ONTARIO

N1R 8A5

24. Email

aiyubsaji@hotmail.com

25. Phone No

519 267 2477

Page 1 of 6

30-JUN-2011

TORONTO
Affix your photo
of size 50X50mm
Approx

OCI Registration Form

FORM XIX (See Rule 25B)
Application for registration as an Overseas Citizen of India under
section 7A of the Citizenship Act,1955

Signature >
CANT024B2N15

Personal Particulars (As in Passport)

1. Surname

LALVA

2. Given Name

ABDULSAMAD SULEMAN

4. Sex

MALE

5. Date of Birth

09-AUG-1960

6. Country(Birth)

INDIA

7. State (Birth)

GUJARAT

8. Place of Birth

DIVA IND

9. Marital Status

MARRIED

10. Nationality

CANADA

11. Visible Distinguishing Mark

2015/ OCI/ 0009394

File Ref No : CANT024B2N15

3. Previous Name

NON

Family Details

12. Father Name

LALVA SULEMAN MUSA

13. Father Nationality

INDIA

14. Mother Name

LALVA AIYSHA SULEMAN

15. Mother Nationality CANADA

16. Spouse Name

FATMA ABDUL SAMAD LALVA

17. Spouse Nationality CANADA

Passport Details

18. Passport No

QE520723

20. Place of Issue

KITCHENER

19. Date Of Issue

Occupation Details

21. Occupation

BUSINESS

22. Employer Address

368 QUEEN STREET WEST CAMBRIDGE ONTARIO

Applicant's Contact Details

23. Present Address

39 WENDY COURT, CAMBRIDGE ONTARIO

N1R 8A5

24. Email

aiyubsaji@hotmail.com

25. Phone No

519 267 2477

Page 2 of 6

30-JUN-2011

TORONTO
Affix your photo
of size 50X50mm
Approx

OCI Registration Form

FORM XIX (See Rule 25B)
Application for registration as an Overseas Citizen of India under
section 7A of the Citizenship Act,1955

Signature >
CANT024B4N15

Personal Particulars (As in Passport)

1. Surname

LALVA

2. Given Name

FAIZAN ABDULSAMAD

4. Sex

MALE

5. Date of Birth

03-NOV-1999

6. Country(Birth)

INDIA

7. State (Birth)

GUJARAT

8. Place of Birth

ANKLESHWAR BHARUCH

9. Marital Status

UNMARRIED

10. Nationality

CANADA

11. Visible Distinguishing Mark

2015/ OCI/ 0009396

File Ref No : CANT024B4N15

3. Previous Name

NON

Family Details

12. Father Name

LALVA ABDULSAMAD SULEMAN

13. Father Nationality

CANADA

14. Mother Name

LALVA FATMA ABDULSAMAD

15. Mother Nationality CANADA

16. Spouse Name

NA

17. Spouse Nationality NA

Passport Details

18. Passport No

QA510097

20. Place of Issue

KITCHENER

19. Date Of Issue

Occupation Details

21. Occupation

NA

22. Employer Address

NA

Applicant's Contact Details

23. Present Address

39 WENDY COURT, CAMBRIDGE ONTARIO

N1R 8A5

24. Email

aiyubsaji@hotmail.com

25. Phone No

519 267 2477

Page 3 of 6

14-JUL-2010

Part B (Other Details Of Applicant(s))

26. Have you/any member of your family applied for OCI Registration earlier?

No

27. Whether the applicant(s) sought asylum before applying for present citizenship?

No

28. Whether the applicant(s) had ever been citizen of Pakistan or Bangladesh at any time?

No

29. Whether either of parents or grandparents or great-grandparents of applicant(s) had ever No

been citizen of Pakistan or Bangladesh at any time?
No

30. Whether the applicant(s) (other than minor child/children) has worked / is working in
Armed Forces/Para-military/Police/security/intelligence organizations?
31. Date and method of acquisition of present nationality
Applicant Name

Acquisition Method

Acquisition Date

Previous Nationality

FATMA ABDUL SAMAD

LALVA

NATURALIZATION

07-JUN-2005

INDIA

ABDULSAMAD SULEMAN NATURALIZATION

LALVA

07-JUN-2005

INDIA

07-JUN-2005

INDIA

FAIZAN ABDULSAMAD
LALVA

NATURALIZATION

File Ref No : CANT024B0N15

32. Details of Family Members who are staying in India,if any

Sr No
1

Name
ABDULAZIZ SULEMAN NANABAWA

Present Address

Relationship/Age

DADHAL-INAM BHARUCH GUJARAT INDIA

BROTHER/42

33. Details of Criminal Proceedings against the applicant(s),if any, anywhere.

Applicant(s) Name

Date Of Incidence

Place Of Incidence Nature Of Incidence

Outcome

FATMA ABDUL
SAMAD LALVA

NA

NA

NA

NA

ABDULSAMAD
SULEMAN LALVA

NA

NA

NA

NA

FAIZAN
ABDULSAMAD
LALVA

NA

NA

NA

NA

34. I/We ............................. do solemnly and sincerely declare that the foregoing particulars stated on this
application are true ,and I/We make ths solemn declaration conscientiously believing the same to be true.
Date ........................
Place ........................

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

** Application for Minor(s)

I am a parent/guardian of .......................................................... to whom the foregoing particulars
relate. I hereby apply on behalf of my/the child (children) for his/her/their registration as an
Overseas Citizen(s) of India.
Date ............................................

Signature of Father/Guardian ............................................

Signature of Mother/Guardian ............................................

** To be filled only for minor applicant(s)

Page 4 of 6

Instructions For Filling Application Form

1. Please write/print fields in BLOCK LETTERS.
2. A person who has not attained the age of 18 years is considered as minor. In case of minor who
cannot sign, his/her le thumb impression may be placed in the Signature Box. Parents should
not sign on behalf of minors.

3. Signature/Thumb impression should be confined in the prescribed box. In case of minor

applicants, parent should NOT sign in the box.

4. Photograph to be affixed on the application should be of square shape of size not less than
51*51mm (with 80% coverage by face). It should have plain light colour background without
border with front view of person's head and shoulders showing the full face in the middle of the
photograph. It should not be stapled and should not have any signature. Photographs that do
not conform to these standards will be rejected and may cause a delay in processing the
applications. Please see standards of acceptable photographs as Photo Link.

File Ref No : CANT024B0N15

5. If there are any objections while processing the applications, the same will be displayed on the
Online Status Enquiry. Please follow the instructions and send requisite documents to the
Indian Mission/ Office where you have applied quoting the File (or Acknowledgement) Number.

6. Part A has to be filled for each applicant of the family and Part B is common for all applicants of the
family.

7. After successful registration , copy of Part A and Part B with an online registration number will be
printed. Application form on Parts A and B, complete in all respects, along with all relevant enclosures
must be submitted to the appropriate office.

8. Enclosures for each applicant:

A. Proof of present citizenship of applicant e.g. copy of Passport / citizenship certificate. In case of
applications filed in India, a copy of valid Visa / Residential Permit should also be enclosed.
B. Evidence of self or parents or grandparents or great-grandparents,
I.
being eligible to become a citizen of India at the time of commencement of the Constitution
i.e. on 26th January, 1950; or
II.
belonging to a territory that became part of India after 15th August, 1947; or
III.
being citizen of India on or after 26th January, 1950. These could be:

Copy of the passport; or

Copy of the domicile certificate issued by the Competent Authority ; or

Any other proof.

C.Evidence of relationship as parent/grandparent/great-grandparents, if their Indian origin is claimed as
basis for grant of Overseas Citizenship of India.

D.
I.

OCI registration fee is US$275 for each applicant or equivalent in local currency to be paid by
way of demand draft.
II.
No registration fee is payable for OCI applications in lieu of Valid PIO cards. However,
Page 5 of 6

SMS/Fax/Agent charges, as applicable, will be levied on the applicant.

9. PIO Card holder should submit a copy of his/her Valid PIO card. The PIO card should be valid as on 9th
Jan, 2015.

10. The documents enclosed with the application should be self attested.
11. This form when completed should be submitted in duplicate (both sets must have original

File Ref No : CANT024B0N15

photographs and signatures along with enclosures)I.

In India to the Foreigners Regional Registration Officer (FRRO), Mumbai, Kolkata, Delhi,
Amritsar, Chennai, Hyderabad, Bangalore, Luck now, Kochi, Kozhikode, Thiruvananthapuram
(Trivandrum) and Goa.
II.
Outside India, to the Indian Mission/ Post having jurisdiction over the country of which the
applicant(s) is a citizen or if he/she is not living in the country of his/her citizenship, to the Indian
Mission/ Post having jurisdiction over the country of which the applicant is ordinarily resident.
12. After receipt of application in concerned office, a File (or Acknowledgement) Number would be issued to
the applicant by way of acknowledgement. This would be communicated by email/post in case of
applications received by post

13. The applicant(s) can verify the status of their application(s) online by quoting the online
Registration Number or File(or Acknowledgement) Number.
14. Please contact Mission/Office where you have applied for OCI registration after 10 days from the date
of dispatch of documents from Delhi or any day after receipt of documents at the Mission/Office
whichever is earlier. Please produce your passports(s) and PIO card, if applicable, in person/through
authorized person for affixing OCI visa sticker and issuance of registration certificate. In case of
applications filed in India with FRRO, applicants should go to the FRRO office in person/through
authorized person.

15. Please check that all fields in the form are filled in and all necessary enclosures are attached
before submission of the form to Indian Mission/Post abroad or FRRO in India.

16. Concealment of any material fact or false representation etc. will lead to cancellation of
registration as Overseas Citizen of India. (Please refer to Section 7D of the Citizenship Act,
1955).

Page 6 of 6