sertaLno. 179373 Fall names of applicant. Country of residence. : Village, ub-coumty and date of bin. CITIZENSHIP VERIFICATION (To be completed by all fresh applicants) 1, Particulars of Applicant County and District of Binh Applicant's tribe/nationality. 2. Particulars of Applicant's Parents Full names of ater. County of residence. ‘County and District of Birth ge, Sub-county and date of birt, Fathers tribe/naionaiy Full names of mother, Maiden name. Country of residence. Village, Sub-County and date of birth County and District of Bith so. Mother's teibe/natonaiy @ ) 3. Citizenship of Uganda By Descent. (Give deus of la generations of erin. (ii) Name wo contemporary descendants (il) Ibo outside Uganda, explain circumstances (ie. Parent's employment outside) By birth (attach birth certificate if available) Binh cetfiate Number Issued by. (i) Atach bith cenifcate of parens ) State country of origin and previous nationaliy’of parents PLO(&) By registration @ Attach photocpy of registration (ii) State date of renunciation of previous citizenship. (ii) Previous nationality. (@) By naturatisation (@ Attach copy of Naturalisation Certificate. Gi) State county of origin. (Delete 2), (b), () or (A) whichever does not apply) 4. Declaration 1.the undersigned, hereby apply forthe issue of a Ugandan Passport, declare tha: (The information given on this application form is correct to the best of my knowledge and belief. Gi) fully understand the legal implication of what Ihave stated above and as such Ido accept any Tegal consequences that may arise out of what I have stated on this form. Signature: Date: 5. Recommendation 1, Certify that to the best of my knowledge and belief, the facts stated on tis form are correct and thatthe applicant was bor in my area of jurisdiction. Local Council I Local Council If ‘Local Council I — ate 1 Certify that to the best of my knowledge and belief the facts stated on this form are correct ‘Resident Dist Commissiner (Official Stamp) Notes: (This form to.be completed by al fresh applicants who wish to acquire Uganda Passports. Gi) Applicants falling under Section 3 (b) should attach relevant birth cerificater,