Application for the Registration of a Birth of a Person Born on Or After

(M.121E)

THE REPUBLIC OF CYPRUS CITIZENSHIP LAW, 1967 – SECTION 4 (2) (b)

APPLICATION FOR THE REGISTRATION OF A BIRTH OF A PERSON BORN ON OR AFTER

THE 16TH DAY OF AUGUST , 1960, IN A FOREIGN COUNTRY

I. PARTICULARS OF THE PERSON WHOSE BIRTH IS TO BE REGISTERED:

1. Date of birth………………………………………………………………………………………………

2. Time of birth (in case of twins, etc.)……………………………………………………………………..

3. Place of birth (full address)………………………………………………………………………………

4. Christian or forenames…………………………………………………………………………………...

5. Sex (male or female)…………………………………………………………………………………….

II. PARTICULARS OF THE FATHER:

6. Surname…………………………………………………………………………………………………

7. Christian or forenames………………………………………………………………………………….

8. Claim to citizenship of the Republic of Cyprus…………………………………………………………

…………………………………………………………………………………………………………..

9. Rank, profession or occupation…………………………………………………………………………

(at the time of child’s birth)

10. Place and date of marriage……………………………………………………………………………..

III. PARTICULARS OF THE MOTHER:

11. Christian or forenames………………………………………………………………………………….

12. Surname…………………………………………………………………………………………………

13. Maiden name……………………………………………………………………………………………

14. Married surname by any previous marriage……………………………………………………………

15. Claim to citizenship of the Republic of Cyprus………………………………………………………..

………………………………………………………………………………………………………….

IV. PARTICULARS OF THE APPLICANT:

16. Surname…………………………………………………………………………………………………

17. Christian or forenames………………………………………………………………………………….

18. Address in full…………………………………………………………………………………………..

19. Relationship to person whose birth is to be registered……………………………………………………. ……………………………………………………………………………………………………………..

20. If not related, state circumstances in which you are applying for registration…………………………….

……………………………………………………………………………………………………………...

V.APPLICATION:

21. I hereby apply for the registration of the birth of (name of person whose birth is to be registered)………

……………………………………………………………………………………………………………...

VI. DECLARATION:

I (full name)…………………………………………………………………………………………………………..

do solemnly and sincerely declare that the foregoing particulars stated in this application are true, and I make this solemn declaration conscientiously believing the same to be true.

(Signatur of applicant)………………………………

Made and subscribed this……………………………..day of………………………………..20……………

before me……………………………………………………at……………………………………………..

(Signed)……………………………………………

Judge or Registrar or Consular Officer or

other person authorised to act in this respect

FOR OFFICIAL USE

Reg. No…………………….

I do hereby certify that the above mentioned birth was registered by me in the Register of Births kept in this Consular Section on the…………………………………………………………………………..

(Seal)……………………………………………

Consular Officer or other person authorised

to act in this respect.