COMUNIORDEJUDAICA DE BELMONTE AMINA Nn VAP APPLICATION FORM TO OBTAIN SEPHARDI CERTIFICATE FORMULARIO DE REQUERIMENTO PARA O CERTIFICADO SEPHARDITA FILL IN THE DOCUMENT ON YOUR COMPUTER. PRINT A COPY AND SIGN WITH A BLUE PEN. EMAIL US A SCANNED COPY E-MAIL; citizenship@belmontelewishcommunity.org -- administrative@belmonteiewishcommunity.ora + Full Name/Nome Completo: * Date of Birth/Data de Nascimento (DD/MM/YYYY, * Nationality(ies)/Nacionalidade(s): * Place of Birth (City/Country)/Naturalidade (Cidade/Pais). * Parents Names/Nome dos Pais: Mother/Mae: Father/Pai: * Full Current Address/Morada Actual Completa: * E-mail Phone/Tel: Description of Documents Submitted / Meio(s) de Prova(s) Apresentados: DECLARATION / DECLARAGAO / 17¥A / DECLARATION / BILDIRI: ENG: | hereby declare that the information given and documents submitted to obtain a Sephardi Certificate are true and correct to the best of my knowledge and honour. In case any information given in this application proves to be false or incorrect, | shall be responsible for the consequences. PT: Declaro que as informagées fomnecidas e os documentos enviados para obter um cerlficado sefardita sao verdadeiros e corretos da melhor maneira possivel. Caso alguma informagao fornecida neste aplicalivo seja falsa ou incorreta, eu serel responsdvel pelas consequéncias ISR: 30:07 09001 o"nnx oA OW N90 OWRWY IY WX NYaz? WAY ODNONAI TOMY yTINAW NAIA YaYA? ANA DTWAY AENK TYAN AK [DD XY MEATS “AN IT AWAAA OMY MWD YTNY AIPM “Aw FR: Je déclare par la présente que les informations fournies et les documents soumis pour obtenir un certiicat sépharade sont véridiques et corrects au meilleur de ma connaissance et de mon honneur. Au cas ol des informations données dans ceite application s‘avéreraient fausses ou incorrectes, je serai responsable des conséquences. TR: Sefarad sertifixasint almak icin verdigim bilgilerimin ve belgelerimin dogru oldugunu gerefim iizerine beyan ederim. Bu bagvuruda verdigim herhangi bir bilginin yanlig oldugunun kanitlanmas! durumunda, sonuglarindan sorumlu olacagim. Signature/Assinatura: Place/Local: Date/Data (DDIMM/YYYY): (Contraio Interna / Internal Use Only N° do Proceso: Data De Entrada: Recebido Por: