Personal Declaration Form Name/D/M/Spouse Name (PDF-

N) Ref Code: OS-2,4,5

A:- Applicants Information
A-1 Citizen Name: Date of Application:
A-2 Existing/Current Name: Desired Name:
A-3 Father/Guardians Name: Desired Father/Guardians Name:
A-4 Mothers Name: Desired Mothers Name:
A-5 Spouses Name: Desired Spouses Name:
A-6 Education: Religion:
B:- Reasons of Modification/ Correction
My Name Fathers Name Mothers Name Spouses Name
is not according to;
B-1 My/fathers/Mothers/Spouses Documents
B-2 My/fathers/Mothers/Spouses Religion
B-3 Social Compulsion
B-4 Any Other Reasons:
C:- Newspaper Information
C-1 1ST Newspaper Name 2nd Newspaper Name (Local): 3rs Newspaper Name (Local):
(National):
C-2
C-3
C-4
D:- Declaration
The undersigned solemnly declare that the above information is correct up to the best of my knowledge,
moreover applicant has never obtained any registration documents. I transfer the authority to NADRA for
cancellation/blocking of registration document, if the information found fake by any mean and I also
authorize NADRA to take ex-parte decision against me accordingly.

Filled by Applicant Filled by parent

Filled by Guardian

(Name) (Signature) (Contact Number)

(Citizen Number if any)
E:- 1st Classs Magistrate/Justice of Peace/Oath Commissioners Information
E-1 Name: CitizenNumber:
E-2 Cell Number: License Number:
E-3 Practice in Courts: Name of Tehsil & District:
E-4 Sign & Stamp:

0315-6154651
0305-2480026


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