TRACK YOUR APPLICATION
 
     
 
 
 
 
 
 
 

FORM FOR A CERTIFICATE OF AGE, NATIONALITY AND DOMICILE

1
Applicant's Name : *
                  First Name

Middle Name

Last Name

Residential Address : *
  Pin code :    Ward :

Mobile No :




2
a
When and where were you born :
b
Where were you educated :



c
Have you ever been to your former native place ? If so, for how many times and for how long for each occasions? When did you last visit it? If not, what prevented you from going there?



d
Are you married? If so, has your wife ever been to your former native place and if yes, how often and and how long on each occassion?



e
How many children have you? Where are they or are they being educated and what are they doing?



f
How many years have you and your family been residing in the state of Maharashtra?



g
Have you or your wife/husband any property in your former native place or elsewhere outside the state of Maharashtra? If yes, where and of what description and value?



h
Have you or your wife/husband any immovable property in the state of Maharashtra? If so, of what description and value?




3
a
When and where was your father/husband born?


b
What was his profession or occupation? 



c
Where was your father's home or place or permanent residence at the time of your birth? 



d
Where was your father when you attained maturity?



e
Is he alive? If not, when and where did he die?





4   Was your father/husband ever in the state of Maharashtra? If he was - 

a
Where was he educated?



b
For what purpose did he come to the state of Maharashtra and work there? 



c
How often did he leave or has he left the state of Maharashtra and for how long on each occassion?



d
If your father/husband alive? Where is he and what is he doing? Has he retired? If so, how long did he remain in the state of Maharashtra after retirement?


e
If your father/husband is dead, had he retired before his death? If so, for how long did he remain in the state of Maharashtra?



f
Has or had your father or mother or husband any immovable property in the state of Maharashtra or elsewhere? If so, where and of what description and value?



g
Do they hold any passport? If so, give details




5
Have or had you any brothers or sisters? If so, how many? Where were they or they being educated? Where are they now and what are they doing? If any of them are dead, where did they die and what were their occupations?




6
Have you every claimed and been deemed to be a native of any place other than a place in the state of Maharashtra for the purpose of your appointment to any office or for conferment upon you of any scholarship, emoluments or other privileges in that place




7
a
For what purpose did you required domicile certificate?



b
Did you apply for a certificate of domicile at any time before and if so, when?



c
Does your husband hold domicile and/ or citizenship certificate? If so, state particulars.



d
Whether you hold any passport? If so, give details



    
 
  1. Residence Proof (Ration Card /Rent / Maintenance Receipt / Landline Telephone Bill / Electricity Bill)
  2. Affidavit in Prescribed Format
  3. Photograph
  4. School Leaving Certificate of Son/ Daughter / Ward / applicant

 
 
     
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