State: Uttar Pradesh

District: Pilibhit
FORM VIIIA
[See rule 10A (1) (g)]
The Citizenship Rules, 2009

APPLICATION FOR NATURALIZATION AS A CITIZEN OF INDIA UNDER SECTION 6B OF THE

CITIZENSHIP ACT, 1955

MHA File Number : 202400816813 Date: 15/05/2024

PART I

1. Full name of the applicant: SANDHYA MANDAL

commonly known by another name, enter such name here:

2. Present address : AMARIYA NAGARIYA COLONY PILIBHIT UTTAR PRADESH 262121 INDIA

3. (a) Sex : FEMALE

(b) Occupation: HOUSEHOLD
(c) If in service, address of employer : NIL
(d) Mark of identification : MOLE ON BACK

4. Please specify which of the minority community from Afghanistan, Bangladesh and Pakistan, you belong to, namely, Hindu,
Sikhs, Buddhists, Jains, Parsis and Christians HINDUS

5. Place and date of birth : NAGARIYA COLONY AMARIYA PILIBHIT, INDIA, 01/01/1965

6. Present nationality, : BANGLADESH

7. Nationality by birth : BANGLADESH

8. (a) Marital status : MARRIED

(b) If married, give date and place of marriage and nationality of the spouse : 01/01/1985, BANGLADESH
(c) Husband's name : ANIL MANDAL

9. Father's full name is KALIPAD VISHWAS resident of KHULNA JILLA and he was born at (with Tehsil, District, State
and Country) NAVONAGAR, BANGLADESH, on 01/01/1935 and is a citizen of BANGLADESH

File Number : 202400816813 Page 1 of 4

10. Mother's full name is RAMA VISHWAS resident of KHULNA JILLA and she was born at (with Tehsil, District, State
and Country) NAVO NAGAR, BANGLADESH on 01/01/1941 and is a citizen of BANGLADESH

11. Whether the applicant is a subject or citizen of any country where an indian citizen is prevented by law or practice of that
country from becoming a subject or citizen of that country by naturalisation NO

12. Indian Language that the applicant has adequate knowledge of (Languages as specified in the Eighth Schedule to the
Constitution of India): HINDI

13. Details of residence in India:

(a) Date of entry into India : 02/01/1965

(b) I have resided in India continuously for a period of twelve months immediately preceding the YES
date of application.

(c) During the fourteen years immediately preceding the said period of twelve months, I have YES
resided in India for a period amounting in the aggregate to not less than five years.

S.No. Details with address of residence in India for the last From To Years & Months
fourteen years
1 2 3 4 5
1 AMARIYA, NAGARIYA COLONY, 01/01/1965 15/05/2024 59 4
PILIBHIT, UTTAR PRADESH-262121 INDIA

14. Reasons for which applicant wishes to acquire Indian citizenship: RELEGIOUS CRUELTY IN BANGLADESH

15. Passport particulars (if available) :

(a) Country : NA
(b) Number : NA

16. Visa valid up to (if available) : NA

17. Details of family members who are staying in India with the applicant :

S.No. Name Present Address Relationship Age

1 2 3 4 5

18. Details of criminal proceedings, if any :

S.No. Nature of the criminal Date and placeof registering the case Present status of the Judgment of
proceedings case the court
1 2 3 4 5

19. Name and address of a person whose affidavit testifying to the character of the applicant is attached herewith:
ARYAN GUPTA, PILIBHIT

PART II

File Number : 202400816813 Page 2 of 4

20. I have/have not previously renounced or been deprived of the citizenship of India.

(If the applicant has renounced his Indian citizenship, here state the date on which the declaration of renunciation
was made; or if he has been deprived of his citizenship, state the date on which and the authority
by whom, the order of deprivation was made.)

21. I have / have not previously applied for naturalization as a citizen of India and the application has/has not been rejected.

22. I hereby declare that my intention is to make India as permanent home and I undertake that the Citizenship of my country
shall stand renounced irrevocably in the event of my application being approved and that I shall not raise any claim on it in
future.

23. I SANDHYA MANDAL do solemnly and sincerely declare that the foregoing particulars, stated in this application are true,
and I make this solemn declaration conscientiously believing the same to be true.

Date............................ Signature of Applicant...................................

Oath of Allegiance

I SANDHYA MANDAL do solemnly affirm (or swear) that I will bear true faith and allegiance to the Constitution of India as
by law established and that I will faithfully observe the laws of India and fulfil my duties as a citizen of India.

Signature of Applicant..............................

Affirmed/Sworn and subscribed this ..................day of........................20...........before me.

*Signature :..................................
.
*Designation :..................................
.

*Signature and designation of the officer authorized under rule 38 of the Citizenship Rules, 2009, before whom the
registration, declaration or oath of allegiance is made or taken.

Affidavit to accompany the application for a certificate of naturalization under the Citizenship Act, 1955.**

In the matter of the application for a certificate of naturalization under the Citizenship Act, 1955, I SANDHYA MANDAL son
of KALIPAD VISHWAS residing at AMARIYA NAGARIYA COLONY PILIBHIT UTTAR PRADESH 262121 INDIA
make oath and do solemnly and sincerely affirm that the statements contained in my application here unto annexed are true to
the best of my knowledge and belief.
If, at any time before a certificate is issued to me, the accuracy of any of the foregoing particulars is affected by an
alteration in circumstances, I undertake to inform the Secretary to the Government of India in the Ministry of Home Affairs in
writing forthwith.

Place............................ Signature of Applicant...................................

Date............................

File Number : 202400816813 Page 3 of 4

**Affidavit to be attested by Notary/Oath Commissioner/Magistrate.

Affidavit testifying the character of the applicant.

(vide item 19)

In the matter of an application for a certificate of naturalisation under the Citizenship Act, 1955, made by SANDHYA
MANDAL (Name of the applicant) I ARYAN GUPTA aged............years, by occupation................................son
of............................................................ residing at PILIBHIT make oath and do solemnly and sincerely affirm that I am an
Indian citizen and I vouch application of (Name of the applicant) SANDHYA MANDAL's good character.

Date............................ Signature...............................

Name: ARYAN GUPTA

Full postal address: PILIBHIT

(This Form complete in all respect shall be submitted to the designated officer under rule 11A within whose
jurisdiction the applicant is ordinarily resident for transmission to the Empowered Committee as specified in rule
11A.)

DOCUMENTS TO BE ATTACHED WITH THE APPLICATION BY THE APPLICANT

1. A copy of any one of the document in Schedule 1A

2. A copy of any one of the document in Schedule 1B
3. An Affidavit in format as in Schedule 1C
4. A copy of valid or expired Foreign Passport, if available
5. A copy of valid or expired Residential Permit, if available
6. One affidavit from self (applicant) and one affidavit from an Indian national testifying to the character of the
applicant in the prescribed language available in the application form.

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