--/ Form No.

BCRS-REP-01

/Date:

/ MINISTRYOF HOME AND CULTURAL AFFAIRS

/DEPARTMENT OF CIVIL REGISTRATION AND CENSUS
/
APPLICATION FORM FOR REPLACEMENT OF CITIZENSHIP IDENTITY /SPECIAL RESIDENCE PERMIT CARD

/Name:

/ID Card No.:

.
.

/Date of Birth (/DD /MM /YYYY):

/Marital Status:

/Reason for request:

/Sex:

/Male

/Female

/Nationality:
/ ID card renewal
/ Damaged card
/ Other typographical errors
/Change of occupation

I declare that all the information provided above is true and correct. If proved to be false, I shall be liable for punishment
as per the Law of the Land.

Affix photo

Affix legal
stamp

/Signature of Applicant
/Date:
.

/Supporting Documents
//Original CID/SRP card
/Others:

. /For Official Use

/Application No.:

/Signature & seal

//Thromde CRCO/DCRCO

/Date:

///Signature of Dzongdag/Thrompon/Dungpa ///Signature of Director General/Director/Division Head