DOMICILE SUBMISSION FORM

Diary No.
PHOTO
Date of
Submission

Full Name GULL SAMINA Fathers Name MUHAMMAD SADIQ

Full Address CHAK R.S P/O KHAS TEHSIL SHUJABAD DISTT.MULTAN

Tehsil SHUJABAD District MULTAN

Date of Arrival 14-12-1992(Since Birth) Occupation STUDENT

Mark of A WOUND ON LIFT EYE

Date of Birth 14-12-1992
Identification BROW

CNIC NO. 36304-8546717-8 Marital Status SINGLE

Mobile NO. Spouse Name NIL

Relative /
Relative /
SELF Attendants
Attendants Name
Contact No.

ATTACHED DOCUMENTS (tick the relevant box)

CNIC Father CNIC Husband CNIC Birth Certificate Bank Receipt

Photographs Property Documents Utility Bill Resident Certificate School Certificate

Voter List Duly Filled P1 Form Domicile Affidavit Form B -

Children Information (write age in years only) IF MARITAL STATUS IS NOT SINGLE
Childs Name - Age - Childs Name - Age -
Childs Name - Age - Childs Name - Age -

Applicants Signature
 INDEX FORM
VERIFICATION OF CREDENTIALS FOR PREPARATION OF DOMICILE CERTIFICATE
Name with
Parentage KAMRAN AKBAR S/D/O MUHAMMAD IQBAL
Complete QASIM BELA, H.NO.377, ST.NO.6, MOHALLAH ALI PARK PHASE 1, MULTAN CANTT,
Address TEH: & DISTT: MULTAN
Property
(if any) N/A

CNIC #s

SELF
(CNIC)
3 6 3 0 2 - 5 1 4 1 0 6 8 - 3

FATHER / HUSBAND
3 6 6 0 3 - 5 0 0 6 1 7 6 - 3

GUARDIAN

ATTACHED DOCUMENTS

School / College Certificate

Voter List

Residential Certificate ATTACHED

Purpose for Certificate FOR ADMISSION / JOB

Other Documents (if any) -------

Stamp Paper of Affidavit

Fee Submission through Challan No. Dated

 UNDER SECTION 23 PAKISTAN CITIZENSHIP RULES,
APPENDIX XIV
FORM P 1
THE PAKISTAN CITIZENSHIP ACT, 1951, (11 OF 1951) & RULES MADE THERE UNDER (VIDE RULES 23)

CERTIFICATE OF DOMICILE
DISTRICT MULTAN
No. ____________ Date: ___________
Whereas GULL SAMINA S/D/O MUHAMMAD SADIQhas applied for certificate of domicile under
the Pakistan Citizenship Act 1951, (11 of 1951) stating with respect to himself / herself the particulars set out
below and satisfied the undersigned that the conditions laid down in section 17 of said act for grant of a certificate
of domicile are fulfilled in the said case GULL SAMINA , NOW THEREFORE, in pursuance of the powers confirmed
by the said act and Rules made there under the undersigned hereby grant to GULL SAMINAthis certificate of
domicile.
IN WITNESS WHERE of I have here to subscribe my name this_____________ day.

Signature _________________________

Name _________________________

Designation _________________________

PARTICULARS RELATING TO THE APPLICANT

Name GULL SAMINA
Fathers Name MUHAMMAD SADIQ
Address in Pakistan CHAK R.S P/O KHAS TEHSIL SHUJABAD DISTT.MULTAN

Address in Country outside of Pakistan NA

Place AS ABOVE Tehsil: SHUJABAD. District MULTAN
Place of Domicile MULTAN Province/Admn. PUNJAB
Date of Birth 14-12-1992
Date of arrival at the place of the Domicile: Since (14-12-1992)
Single/Widow/Widower SINGLE
Name of Wife or Husband N/A
Name of Children & their ages N/A
Trade or Occupation STUDENT
Marks of Identification A WOUND ON LIFT EYE BROW

Signature _________________________ PHOTO

Name _________________________
Designation _________________________
Date _________________________
 APPENDIX VIII
[ Form P ]
(Vide Rule 23 Pakistan Citizenship Rule 1951)
Application for a Certificate of Domicile in Pakistan
To,
The District Coordination Officer,
Multan.
Sir,
GULL SAMINA S/O MUHAMMAD SADIQ
I

Age 14-12-1992 years resident of

CHAK R.S P/O KHAS TEHSIL SHUJABAD DISTT.MULTAN
hereby state I was formerly a resident of

I have arrived in Pakistan Tehsil SHUJABAD District MULTAN

Province/ Admn. PUNJAB in Pakistan BY BIRTH

I have residence continuously in Pakistan for a period of __SINCE (BIRTH)__ year month
immediately in proceeding this declaration and hereby my intention to domicile of Original in MULTAN
DISTRICT and with a view to require the domicile of Pakistan. I declare my intention to take up fixed addition
in Pakistan during the reminder of my life.
I further affirm that I had migrated to India and returned of Pakistan between the 1st March 1948
to that or this application Exception valid.
Visa no. ___________N/A______________ Casted __________N/A__________
Issued by Pakistan Passport office at
Other particulars are given below
SINGLE /SINGLE /Widow /Widower SINGLE

Name of Wife / Husband N/A

Name of children and their ages N/A

Trade of occupation STUDENT

Marks of identification A WOUND ON LIFT EYE BROW

I do solemnly a firm that above statements is true to the best of knowledge and belief.

Attestation __________________________ Signature ____________________________

Designation _________________________ Place ____________MULTAN__________

Place and date _______________________

 Certified that the applicant GULL SAMINA S/D/O MUHAMMAD SADIQ to a bonafide

permanent resident of CHAK R.S P/O KHAS TEHSIL SHUJABAD DISTT.MULTAN and residing in this area by

birth or more than three years.

CNIC # 36304-8546717-8 ()

TEHSILDAR

Certified that the applicant GULL SAMINAS/D/O MUHAMMAD SADIQ to a bonafide

permanent resident of CHAK R.S P/O KHAS TEHSIL SHUJABAD DISTT.MULTAN and residing in this area by

birth or more than three years.

CNIC # 36304-8546717-8 ()

TEHSILDAR
 CHALAN NO. 32 CHALAN NO. 32
Chalan of Cash paid into the Treasury Sub-Treasury Provincial Chalan of Cash paid into the Treasury Sub-Treasury Provincial
National Bank of Pakistan, Multan CENTRAL National Bank of Pakistan, Multan CENTRAL
Reserve Bank Reserve Bank
State Bank of Pakistan State Bank of Pakistan
To be filed in by the To be filed in by the
To be filled in by Remitter Departmental office or the To be filled in by Remitter Departmental office or the
Treasury Treasury
By Whom Name or Amount By Whom Name or Amount
Designation of the
Full particles of Head of Designation of the
Full particles of Head of
the remittances Order to the the remittances Order to the
perdaughter on
& authority (if the perdaughter on
& authority (if the
whose behalf Bank whose behalf Bank
money is paid
any) Amount money is paid
any) Amount

Dated Dated

C-033806 CITIZENSHIP NATIONSHEHRAZZATION

C-033806 CITIZENSHIP NATIONSHEHRAZZATION

Correct Rs. Correct Rs.
Received & Received &
GULL SAMINA Fee for Grant Receipt GULL SAMINA Fee for Grant Receipt
Domicile Rs.200/- Domicile Rs.200/-
S/O S/O

PASSPORT & COPYRIGHTS FEE

PASSPORT & COPYRIGHTS FEE

-SAME-

-SAME-
MUHAMMAD MUHAMMAD
SADIQ SADIQ
SHUJABAD Signature and SHUJABAD Signature and
DISTT.MULTAN Full DISTT.MULTAN Full
Designation Designation
OTHER RECEIPT

OTHER RECEIPT
of the Officer of the Officer
ordering the ordering the
money to be money to be
TOTAL Rs.200/- Pakistani TOTAL Rs.200/- Pakistani

Signature To be used only in the case of Signature To be used only in the case of
Rupees (In words) Two Hundred Rupees Only Remittance to Bank through Rupees (In words) Two Hundred Rupees Only Remittance to Bank through
An officer of the Government An officer of the Government

Received Payment Dated Treasury Officer

Received Payment Dated Treasury Officer Treasurer Amount Agent / Manager
Treasurer Amount Agent / Manager
Date:
Date:
 A F F I D A V I T
(By Parents of Child)

I MUHAMMAD SADIQ S/D/O NOOR MUHAMMAD

CHAK R.S P/O KHAS TEHSIL SHUJABAD
CNIC# 36304-1398840-1 R/O DISTT.MULTAN

SHUJABAD DISTT.MULTAN ,

do hereby solemnly affirm as under:

1. MR. GULL SAMINA is my real son/daughter and is less than 18-years of age.

2. I affirm the truth of the statement made in application (Form-P) for issuing of a certificate of
domicile in favour of my son/daughter.

3. My son/daughter has been continually residing in Pakistan for a period not less than one year and
intends to live permanently in Pakistan.

4. My son/daughter is not a citizen or national of any other country.

5. My son/daughter is a permanent resident of SHUJABAD. Sub-Division District Multan.

6. My son/daughter is a permanent resident of District Multan at the address given above.

7. My son/daughter has not obtained domicile certificate from any other district and he/she has not
applied for domicile certificate before this.

8. Domicile Certificate may be cancelled if any other Domicile Certificate is already issued to my
son/daughter indicating any other Sub-Division of District Multan.

Attested by:

Name: _ _ Thumb Impression: _ _

Designation: _ _ Signature: _ _

Dated: _ _ Dated: _ _

[FOR ATTESTOR] [FOR PARENT]

 A F F I D A V I T
(By Applicant)

I GULL SAMINA S/D/O MUHAMMAD SADIQ

CHAK R.S P/O KHAS TEHSIL SHUJABAD
CNIC# 36304-8546717-8 R/O
DISTT.MULTAN

do hereby solemnly affirm as under:

1. I affirm the truth of the statement made in application (Form-P) for issuing of a certificate of
domicile in my favour.

2. I have been continually resident in Pakistan for a period not less than one year and intend to live
permanently in Pakistan.

3. I am not a citizen or national of any other country.

4. I am a permanent resident of SHUJABAD. Sub-Division, District Multan.

5. I am a permanent resident of District Multan at the address given above.

6. I have not obtained domicile certificate from any other district and I have not applied for domicile
certificate before this.

7. My Domicile Certificate may be cancelled if any other Domicile Certificate is already issued to me
indicating any other Sub-Division of District Multan.

Attested by:

Name: _ _ Thumb Impression: _ _

Designation: _ _ Signature: _ _

Dated: _ _ Dated: _ _
[FOR ATTESTOR] [FOR APPLICANT]