FORM 8 - IRISH NATIONALITY AND CITIZENSHIP ACT 1956

Ver 4.0 Nov 11

APPLICATION BY A PERSON OF FULL AGE FOR NATURALISATION AS AN IRISH CITIZEN

IMPORTANT! PLEASE READ CAREFULLY
DO NOT SUBMIT YOUR APPLICATION FORM WITHOUT PROPERLY COMPLETING THE STATUTORY DECLARATION AND ENCLOSING ALL OF THE REQUIRED DOCUMENTATION SPECIFIED BELOW. IF DOCUMENTS ARE MISSING, IF COPIES OF CERTIFICATES ARE NOT CERTIFIED AS TRUE COPIES OF ORIGINALS, OR IF THE FORM IS NOT FULLY COMPLETED, YOUR APPLICATION WILL BE REFUSED AS THE REQUIREMENTS OF SECTION 17 OF THE 1956 ACT HAVE NOT BEEN SATISFIED AND YOUR APPLICATION FEE WILL NOT BE REFUNDED.

CERTIFIED COPIES:
You are required to include certified copies of your birth certificate and any other certificates required (see below) with your application. In order to make a certified copy, you must take your original certificates/documents to your solicitor or a notary public, commissioner for oaths or peace commissioner and ask them to make a photocopy of each document and certify that it is a true copy of the original i.e. stamp and sign it True copy of the original. If certificates/documents are not in English or Irish, a translation by a professional translator is required. A copy of the translation as well as the copy of the original document must be certified by a notary public, commissioner for oaths, peace commissioner or solicitor as being a true copy of the original. Please note that these documents may be authenticated with authorities in the issuing country.

YOU MUST PROVIDE ALL OF THE FOLLOWING DOCUMENTATION WITH YOUR APPLICATION:

Certified colour copy of the page of your current passport/travel document containing your photograph.* Certified copy of your original civil birth certificate and certified copy of a translation into English if the certificate is in a language other than English or Irish.* Copy of your garda national immigration bureau card. Letter from your current and previous employers covering employment dates from your date of arrival to date of application, showing commencement and finish dates for each job. Copy of your current P21 or P60 statement from the revenue commissioners if you are in employment. Copies of 3 months pay slips in the previous 6 months if you are in employment. Copy of bank statements for all of your bank accounts for 3 of the previous 6 months. Copy of Irish medical registration letter (only applicable if you are a doctor). Evidence of marriage to or being the civil partner of a deceased person who, at the date of death was an Irish citizen, if applicable. (Certified copies of certificates, court documents as applicable). The Statutory Application Fee of 175. This should be in the form of a bankers draft or postal order payable to the Secretary General, Department of Justice and Equality. Please note that this is non-refundable and is required for each application for a certificate of naturalisation. If you: o have not completed all questions on the application form or you have not inserted your full name and signed the Statutory declaration in the presence of an approved witness, then your application will be refused as the requirements of Section 17(a) of the Irish Nationality and Citizenship Act 1956, as amended have not been met; o have not enclosed the required documentation to support your application, then it will be refused as the requirements of Section 17(b)(ii) of the Irish Nationality and Citizenship Act 1956, as amended have not been met. However, this decision will be delayed for 4 weeks, in order to afford you a further opportunity to provide the omitted documentation; o have not enclosed the Statutory Application Fee of 175, then your application will be refused under Section 17(b)(i) of the Irish Nationality and Citizenship Act 1956, as amended. No assessment of your application will be undertaken. If a decision is made on your application as the requirements of section 17 of the Irish Nationality and Citizenship Act 1956 have not been satisfied then that is the final action on that application. There is no provision under the Irish Nationality and Citizenship Act 1956, as amended, for appeal of decisions on applications for a certificate of naturalisation. However, you can re-apply at any time, but will be required to submit the application fee for all such applications.

YOU MUST ALSO PROVIDE OTHER INFORMATION/DOCUMENTATION REQUIRED AS FOLLOWS:

If your application is based on having 5 years residence: Evidence of residency permission i.e. a copy of your passports showing residency permission stamps for a period of 1
year immediately prior to the application and 4 years in the 8 year period before that (i.e. 5 x 365 days plus one day for each permission period in which 29 February falls (leap year)).
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If your application is based on having 5 years residence (cont.): If you are an E.U. citizen for more than five years please submit proof of residence in the State amounting to for a total
of five years in the last nine years, to include the year prior to application. Please submit three different proofs of residence for each year showing name and address for this period i.e. household bills (gas, electricity, phone or cable/satellite TV), bank statements, revenue letters, mortgage agreement, social welfare, letter from employment, doctors letter etc.

If you are an E.U. citizen for less than five years please submit copy of your passport showing permission to remain stamps from date of arrival in the State to date of becoming a E.U. citizen and proof of residence in the State from date of becoming a E.U. citizen to date of application. Please submit three different proofs of residence for each year showing name and address for this period i.e household bills (gas, electricity, phone or cable/satellite TV), bank statements, revenue letters, mortgage agreement, social welfare, letter from employment, doctors letter etc.

If your application is based on Refugee Status: Copy of letter confirming refugee status. If your application is based on marriage to or being the civil partner of an Irish citizen: Copy of documentary proof of Irish spouses/civil partners entitlement to Irish citizenship (certified copy of Irish

spouses/civil partners birth certificate if born in Ireland / copy of foreign birth register entry / spouses or civil partners parents birth certificate if latter was born in Ireland / copy of naturalisation certificate). Certified copy of marriage certificate / civil partnership registration*. NOTE: If your civil partnership was registered in a country other than the State, then recognition of this relationship by the State is determined by reference to the Civil Partnership (Recognition of Registered Foreign Relationships) Order 2010. You should satisfy yourself that your registered relationship is recognised before making an application based on being the civil partner of an Irish citizen. The relevant sworn affidavit (this is included with your application form) must be completed by the Irish spouse/civil partner in the presence of a legal witness (Commissioner for Oaths, Peace Commissioner, Notary Public or Practising Solicitor). Copies of 3 different proofs of residence in the State for both applicant and spouse/civil partner for 3 months prior to the date of application showing date and name and current address. Proofs include household bills (gas, electricity, phone or cable/satellite TV), bank Statements, revenue, mortgage agreement, social welfare, letter from employment, doctors letter etc. Evidence of residency permission i.e. a copy of your passport(s) showing residency permission stamps for a period of 1 year immediately prior to the application and 2 years in the 4 year period before that, equalling 3 years in total, or alternatively proof of residence in the State for this period. Please submit three different proofs of residence for each year showing your name and address and date of issue i.e. household bills (gas, electricity, phone or cable/satellite TV), bank statements, revenue letters, mortgage agreement, social welfare, letter from employment, doctors letter etc.

NOTE: PLEASE ENSURE

THAT THE RELEVANT DECLARATION ON PAGE 11 OR 12 OF THIS DOCUMENT HAS BEEN SIGNED BY YOUR SPOUSE/CIVIL PARTNER AND WITNESSED ON THE SAME DATE AS THE STATUTORY DECLARATION IS WITNESSED OR AT A LATER DATE.

If your application is based on Irish Associations: Certified copies of all documentation proving your Irish associations** e.g. all birth and/or marriage certificates or civil

partnership agreement needed to show association, certified copy of foreign birth registry entry, copy of naturalisation certificate etc. Evidence of residency permission i.e. a copy of your passport(s) showing residency permission stamps for your periods of residence in the State.

* If you do not have your birth certificate (or marriage certificate/civil partnership registration, if married to or are the civil partner of an Irish citizen) then you should get them from the relevant authorities in the country where your birth and/or marriage/civil partnership was registered before making an application for a certificate of naturalisation. In certain limited circumstances a birth affidavit may be accepted in lieu of a Birth Certificate, where the certificate is not available and cannot be obtained. Please note that this is only accepted in exceptional circumstances. If you are not in possession of or have lost your birth certificate, an affidavit will NOT be accepted. You must obtain it from the relevant authorities before applying. ** Section 16(2) of the Irish Nationality and Citizenship Act 1956, as amended, defines being of Irish associations as meaning 'related by blood, affinity, adoption to, or is the civil partner of a person who is an Irish citizen'.

PLEASE NOTE THAT THE MINISTER WILL DECIDE IN HIS ABSOLUTE DISCRETION WHETHER TO WAIVE THE CONDITIONS FOR NATURALISATION, OR ANY OF THEM, WHERE THE PROVISIONS OF SECTION 16 APPLY. AS A GENERAL GUIDE, WHERE THIS SECTION APPLIES, YOU WILL NORMALLY BE REQUIRED TO HAVE 3 OR MORE YEARS RECKONABLE RESIDENCE IN THE STATE. THERE IS NO RIGHT TO HAVE ANY CONDITIONS FOR NATURALISATION WAIVED IN ANY CASE; IT IS ENTIRELY AT THE MINISTERS ABSOLUTE DISCRETION.
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DETAILED GUIDANCE ON FILLING OUT THE APPLICATION FORM

ANSWER ALL QUESTIONS. IF A QUESTION DOES NOT APPLY, WRITE N/A IN THE BOX PROVIDED.
Section 1: Name 1.1 Write all of your current given name/names. These should be the same as on your birth certificate. 1.2 Write your current family name. 1.3 If you have ever used another name, write it here and answer 1.4 and 1.5. 1.4 Please give the reason for name change e.g. marriage, deed poll. 1.5 Please give the date your name changed. Section 2: Identification 2.1 Write your birthplace as recorded on your Birth Certificate. 2.2 Write your Country of birth as recorded on your Birth Certificate. 2.3 Write your Date of birth as recorded on your Birth Certificate. 2.4 Tick the box that shows your correct gender. 2.5 Write your present nationality. 2.6 Write your PPSN, which has 7 digits and a letter at the end. It is issued by the Department of Social Protection. 2.7 Write your GNIB number (This is found on your GNIB card). 2.8 Write your Person Identity Number: (69/12345/12 old version or 123456-12 new version ID issued from Oct 2011) Section 3: Residential Address 3.1 Write your current address. 3.2 Write your e-mail address if you have one. 3.3 Write your day-time telephone number. 3.4 Write your evening telephone number if you have one. 3.5 Write your mobile telephone number if you have one. Section 4: Previous Addresses Please list all your addresses for the last 9 years if a standard application or 5 years if married to an Irish citizen. Include Irish and overseas addresses. Section 5: Residency Permissions 5.1 Write the date when you first arrived in Ireland. 5.2 Write your Passport Number at the time of arrival in Ireland. 5.3 If not providing output from the online residency checking guide, enter details of all of the residency permissions stamped on your passport(s) by an Immigration Officer. 5.4 Tick the appropriate box. Please give details of any period spent studying in Ireland for the last 9 years. 5.5 Tick the appropriate box. Please give details of any period spent in the asylum process for the last 9 years. Section 6: Residence following Naturalisation 6.1 Tick the appropriate box. 6.2 Tick the appropriate box. 6.3 If you answered "no" to either question 6.1 or 6.2 please state the country that you intend residing in following naturalisation. Section 7: Status 7.1 Tick the appropriate box that indicates your marital status. 7.2 Tick Yes or No 7.3 Tick Yes or No 7.4 Tick Yes or No Section 8: Family Details 8.1 Write the full name of your father and mother and in each case their date of birth, the place and country where they were born and their present nationality. Write their birth name if different from their current last name. 8.2 Write the full name of each of your children, their birth name if different, specify whether they are male or female, state their date of birth, the place and country where they were born and their present nationality. Section 9: Means of Support 9.1 Tick the appropriate box. 9.2 Write the Name and Address of your employer if you are in employment. If you are self-employed, or you are a partner or director of a company, write the address used for business. 9.3 Tick the appropriate box. 9.4 Give details of any social welfare payments that you are receiving and/or have received in the past 3 years and the reason why you obtained that payment/support. 9.5 Give details of your periods of employment in the past 5 years.
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Section 10: Previous Applications 10.1 Tick the appropriate box. 10.2 If applicable, write the year in which you made a previous application. 10.3 If applicable, write your previous application reference number e.g. 68/1234/12 (old type) or 1234567-CITZ-10 (new type issued from Oct 2011) Section 11: Background 11.1 Tick the appropriate box. 11.2 Tick the appropriate box. 11.3 If applicable, write the date of conviction, judgement or offence. 11.4 If applicable, write the place where the conviction, judgement or offence occurred. 11.5 If applicable, write the outcome. 11.6 to 11.11 Tick the appropriate box for each question. If you answered yes to any of these questions, you should provide details and an explanation in the additional details section provided for this purpose. Section 12: Irish Associations 12.1 If you are applying for naturalisation on the basis of descent or Irish associations please tick the appropriate box and give further details here. If you need to you can provide additional information on a separate sheet. Section 13: Application based on Marriage to or Civil Partnership of an Irish Citizen This section should be completed if you are applying on the basis of your marriage to or being the civil partner of an Irish citizen. Evidence is required and the relevant sworn declaration at the end of the form (blue pages) must be completed by your Irish citizen spouse/civil partner and witnessed by an authorised person (e.g. Solicitor, Peace Commissioner, Notary public, Commissioner for oaths). 13.1 Tick the appropriate box. 13.2 Tick the appropriate box. 13.3 Give the date you got married or the date you registered your civil partnership. 13.4 Give the place and country where you got married or where your civil partnership was registered. 13.5 State how your spouse/civil partner gained Irish citizenship. Section 14: References 14.1 This section should be completed by three Irish Citizens who are willing to act as referees for you. Statutory Declaration A Statutory declaration is a written Statement, declared to be true by you in the presence of an authorised person. By signing this declaration you are stating that you understand the application form and that the facts provided in the application form are true and correct to the best of your knowledge. You should complete boxes A1, A2 and A3 and your authorised witness should complete W1, W2, W3 (either W3.0, W3.1, W3.21, W3.22, W3.23, W3.24 or W3.25), W4, W5,W6, W7 and W8. Section 15A Declaration This declaration must be completed by your Irish citizen spouse/civil partner where you are applying on the basis of your marriage to or being the civil partner of an Irish citizen. There are 2 versions of the declaration one for spouses the other for civil partners. The appropriate declaration must be signed in the presence of an authorised person (e.g. Solicitor, Peace Commissioner, Notary public, Commissioner for oaths). *NOTE RE IDENTITY DOCUMENTS Acceptable identity documents are birth certificates and passports. If you do not have your birth certificate or passport (and marriage certificate/civil partnership registration, if your application is based on marriage to or being the civil partner of an Irish citizen) then you should get them from the relevant authorities in the country of origin and/or country where the marriage/civil partnership was registered before making an application for a certificate of naturalisation. A passport may be accepted in lieu of a birth certificate, where there are satisfactory reasons why the birth certificate cannot be produced. Please note that provision of both documents will help us process your application faster. Use of Birth Affidavit In certain limited circumstances an affidavit may be accepted in lieu of a Birth Certificate, where the certificate is not available and cannot be obtained. Please note that this is only accepted in exceptional circumstances. If you are not in possession of or have lost your birth certificate, an affidavit will NOT be accepted. You must obtain it from the relevant authorities before applying.

NOTE: THIS FORM IS FOR APPLICATIONS BY PERSONS AGED 18 YEARS OR OLDER ONLY
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FORM 8 - IRISH NATIONALITY AND CITIZENSHIP ACT 1956

Ver 4.0 Nov 11

APPLICATION BY A PERSON OF FULL AGE FOR NATURALISATION AS AN IRISH CITIZEN

Please note before completing the form: Ensure that the information you provide is true and correct. Section 29A of the Irish Nationality and Citizenship Act 1956, as amended provides that a person who knowingly or recklessly makes a declaration under this Act, or a statement for the purposes of any application under this Act that is false or misleading in any material respect, shall be guilty of an offence and shall be liable on summary conviction to a fine not exceeding 3,000 or imprisonment for a term not exceeding 12 months, or to both, or on conviction on indictment to a fine not exceeding 50,000 or imprisonment for a term not exceeding 5 years, or to both. A certificate of naturalisation may be revoked if the certificate was procured by fraud, misrepresentation,(whether innocent or fraudulent), or concealment of material facts or circumstances. Use a black pen and PRINT IN BLOCK CAPITALS. Cross out any errors Do not use correction fluid Answer ALL questions. If a question does not apply put N/A as your answer

1. NAME
1.1 CURRENT GIVEN/FIRST NAME(S): 1.2 CURRENT FAMILY/LAST NAME: 1.3 PREVIOUS NAME(S): 1.4 REASON FOR CHANGE: Documentary evidence is required 1.5 DATE OF CHANGE TO PRESENT NAME:
DAY MONTH YEAR

2. IDENTIFICATION
2.1 PLACE OF BIRTH: 2.2 COUNTRY OF BIRTH:

2.3 DATE OF BIRTH: 2.4 GENDER: 2.5 PRESENT NATIONALITY: 2.6 YOUR PPS NUMBER:
(If a Personal Public Service No. has been issued to you)

DAY

MONTH

YEAR

MALE

FEMALE

2.7 YOUR GNIB NUMBER: 2.8 YOUR PERSON IDENTITY NUMBER: Please supply a photocopy of your Long Form Civil Birth Certificate that has been certified to be a true copy of the original by a notary public, commissioner for oaths, peace commissioner or solicitor. If you do not have your birth certificate you must get it before lodging this application.

3. RESIDENTIAL ADDRESS
3.1 PRESENT ADDRESS:

3.2 EMAIL ADDRESS: 3.3 DAYTIME TELEPHONE NUMBER: 3.4 EVENING TELEPHONE NUMBER: 3.5 MOBILE NUMBER:
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4. PREVIOUS ADDRESSES
Please provide details of ALL of your previous addresses for the past 9 years, both in the State and abroad, starting with the most recent one: Address Country From To

Continue on separate sheet if necessary.

5. RESIDENCY PERMISSIONS
5.1 DATE OF ARRIVAL IN IRELAND:
DAY MONTH YEAR

5.2 PASSPORT NUMBER: 5.3 STATUTORY RESIDENCY CONDITIONS ARE PRESCRIBED IN SECTION 15 AND SECTION 15A OF THE 1956 ACT AND COMPLIANCE WITH THESE CONDITIONS IS ASSESSED ON THE BASIS OF YOUR LEGAL RECKONABLE RESIDENCE IMMEDIATELY PRIOR TO THE DATE OF APPLICATION I.E. THE DATE YOU SIGN THE STATUTORY DECLARATION AT THE END OF THIS FORM. You should have one years continuous reckonable residency in the year immediately prior to the date of application and, during the 8 years immediately preceding that period had a total residence in the State of 4 years - i.e. 5 x 365 days (366 days in a leap year). A RESIDENCY CALCULATOR IS PROVIDED ON THE CITIZENSHIP SECTION AT HTTP://WWW.INIS.GOV.IE AS A GUIDE TO ASSIST YOU IN CHECKING IF YOU SATISFY THE STATUTORY CONDITIONS FOR RESIDENCY. YOU SHOULD ENTER YOUR PERMISSIONS AS EVIDENCED IN YOUR PASSPORT AND VERIFY THAT YOU SATISFY RESIDENCY REQUIREMENTS. PLEASE PRINT A COPY OF THE REPORT AND INCLUDE IT WITH YOUR APPLICATION OR, ALTERNATIVELY, PLEASE PROVIDE DETAILS OF ALL OF YOUR STAMPS IN THE NINE YEARS PRIOR TO THE DATE OF THIS APPLICATION BELOW: Stamp Valid From Stamp Valid To Stamp Type (1, 3, 4, 5, 6 are reckonable. 1A, 2, 2A are not reckonable) Total Days

1 2 3 4 5 6 7 8 5.4 WAS ANY PART OF YOUR TIME IN THE STATE IN THE NINE YEARS PRIOR TO YOUR APPLICATION FOR THE PURPOSES OF STUDY?

YES

NO

Page 6 of 14

If any of your time in the State in the nine years prior to your application was for study purposes please complete the details below: From To Name and Address of School/College/University

5.5 WAS ANY PART OF YOUR TIME IN THE STATE IN THE NINE YEARS PRIOR TO YOUR APPLICATION SPENT AS AN ASYLUM SEEKER?

YES

NO

If any part of your time in the State in the last nine years was spent as an asylum seeker please complete the details below: From To Outcome Reference Number

Please supply a copy of letter confirming Refugee Status if appropriate.

6. RESIDENCE FOLLOWING NATURALISATION (Tick one box only)

6.1 DO YOU INTEND, FOLLOWING NATURALISATION, TO HAVE YOUR USUAL OR PRINCIPAL PLACE OF RESIDENCE IN THE STATE?

YES

NO

6.2 IF YOU ARE MARRIED TO, OR ARE THE CIVIL PARTNER OF, AN IRISH CITIZEN, DO YOU INTEND, FOLLOWING NATURALISATION, TO HAVE YOUR USUAL OR PRINCIPAL RESIDENCE IN THE ISLAND OF IRELAND? YES 6.3 IF YOU ANSWERED NO TO QUESTION 6.1 OR 6.2 PLEASE INDICATE YOUR INTENDED COUNTRY OF RESIDENCE FOLLOWING NATURALISATION:

NO

NOT APPLICABLE

7. STATUS
7.1 Give your current status: SINGLE MARRIED SEPARATED DIVORCED WIDOW(ER) CIVIL PARTNER

7.2 ARE YOU THE WIDOW / WIDOWER OR WERE YOU

THE CIVIL PARTNER OF A DECEASED PERSON WHO AT DATE OF DEATH WAS AN IRISH CITIZEN? 7.3 HAVE YOU, SINCE THE DATE OF DEATH OF YOUR IRISH SPOUSE / CIVIL PARTNER, ACQUIRED THE NATIONALITY OF ANOTHER COUNTRY? 7.4 HAVE YOU, SINCE THE DATE OF DEATH OF YOUR IRISH SPOUSE / CIVIL PARTNER, MARRIED OR BECOME THE CIVIL PARTNER OF ANOTHER PERSON?

YES

NO

YES

NO

YES

NO

8. FAMILY DETAILS:
8.1 Please complete the details below in respect of your mother and father and spouse / civil partner (if applicable):
NAME MOTHER FATHER
SPOUSE / CIVIL PARTNER

BIRTH LAST NAME (IF DIFFERENT)

DATE OF BIRTH

PLACE AND PRESENT COUNTRY OF BIRTH NATIONALITY

8.2 Please complete the details below in respect of your children:

NAME GENDER CHILD'S PLACE OF RESIDENCE DATE OF BIRTH PLACE & COUNTRY PRESENT OF BIRTH NATIONALITY

Page 7 of 14

9. MEANS OF SUPPORT:
9.1 Are you: EMPLOYED SELF-EMPLOYED RETIRED STUDYING UNEMPLOYED OTHER

9.2 If you are in employment, please give the name and address of your employer or if you are self-employed, a partner or a director of a company, please provide the name and address used for business:

9.3 HAVE YOU BEEN IN RECEIPT OF A SOCIAL ASSISTANCE PAYMENT OR OTHER STATE SUPPORT IN THE PAST 3 YEARS? 9.4 If you answered Yes to question 9.3 please give: TYPE OF PAYMENT/SUPPORT: FROM: TO:

YES

NO REASON FOR OBTAINING SOCIAL WELFARE SUPPORT:

9.5 Details of your employment(s), if any, in the past 5 years:

FROM: TO: JOB/ROLE: EMPLOYER:

10. PREVIOUS APPLICATIONS:

10.1 HAVE YOU APPLIED FOR IRISH CITIZENSHIP BEFORE? YES
DAY MONTH YEAR

NO

If you answered yes to question 10.1 please give: 10.2 DATE OF APPLICATION: 10.3 APPLICATION REFERENCE NUMBER:

11. BACKGROUND:
11.1 HAVE YOU EVER COMMITTED ANY OFFENCES AGAINST THE LAWS OF IRELAND OR ANY OVERSEAS COUNTRY? 11.2 DO YOU HAVE ANY CONVICTIONS IN THE STATE OR ANY OTHER COUNTRY (INCLUDING TRAFFIC OFFENCES) OR ANY CIVIL JUDGEMENTS MADE AGAINST YOU?

YES

NO

YES

NO

If you answered Yes to question 11.1 and/or 11.2 please answer questions 11.3 to 11.5. If more than one instance provide details in the additional details section.
11.3 DATE OF CONVICTION OR JUDGEMENT: 11.4 PLACE WHERE CONVICTION OR JUDGEMENT TOOK PLACE: 11.5 OUTCOME:
DAY MONTH YEAR

11.6 HAVE YOU EVER BEEN CHARGED / INDICTED INSIDE OR OUTSIDE THE STATE WITH A CRIMINAL OFFENCE FOR WHICH YOU HAVE NOT YET BEEN TRIED IN COURT? 11.7 ARE YOU, OR HAVE YOU BEEN, THE SUBJECT OF AN INVESTIGATION IN IRELAND BY AN GARDA SOCHNA (IRISH POLICE)?
Page 8 of 14

YES

NO

YES

NO

11.8 HAVE YOU EVER BEEN INVOLVED IN, OR BEEN SUSPECTED OF INVOLVEMENT IN, WAR CRIMES, CRIMES AGAINST HUMANITY OR GENOCIDE? 11.9 HAVE YOU EVER BEEN ASSOCIATED WITH, BEEN A MEMBER OF, OR GIVEN SUPPORT, INCLUDING FINANCIAL SUPPORT, TO A TERRORIST ORGANISATION, OR BEEN INVOLVED IN, SUPPORTED FINANCIALLY OR OTHERWISE, OR ENCOURAGED TERRORIST ACTIVITIES? 11.10 HAVE YOU EVER, BY ANY MEDIUM, EXPRESSED VIEWS THAT JUSTIFY OR GLORIFY TERRORIST VIOLENCE OR THAT MAY ENCOURAGE OTHERS TO TERRORIST ACTS OR OTHER SERIOUS CRIMINAL ACTS? 11.11 HAVE YOU ENGAGED IN ANY OTHER ACTIVITIES THAT MIGHT INDICATE THAT YOU MAY NOT BE CONSIDERED A PERSON OF GOOD CHARACTER?

YES

NO

YES

NO

YES

NO

YES

NO

If you answered yes to any of the questions 11.6 to 11.11 please provide details in the additional details section. You may also use this section to give details in relation to questions 11.1 - 11.5.
Please note that reports are obtained from An Garda Sochna and other agencies as required including the Department of Social Protection and the Department of Foreign Affairs and all information provided by you is subject to verification.

ADDITIONAL DETAILS

Continue on separate sheet if necessary.

12. APPLICATION BASED ON IRISH ASSOCIATIONS:

12.1 If your application is based on your Irish descent or Irish Associations, please give details below:
DETAILS: (Irish Associations is defined as being related by blood, affinity or adoption to an Irish citizen).

Continue on separate sheet if necessary.

Please submit copies of all documentation proving your Irish Descent/Associations e.g. birth certificates, foreign birth registry entry, naturalisation certificates, proofs of citizenship. All copies should be certified to be true copies of original documents by a notary public, commissioner for oaths, peace commissioner or solicitor

13. APPLICATION BASED ON MARRIAGE TO OR CIVIL PARTNERSHIP WITH AN IRISH CITIZEN

13.1 IS YOUR APPLICATION BASED ON YOUR MARRIAGE TO AN IRISH CITIZEN? 13.2 IS YOUR APPLICATION BASED ON BEING THE CIVIL PARTNER OF AN IRISH CITIZEN? 13.3 DATE OF MARRIAGE/REGISTRATION OF CIVIL PARTNERSHIP: 13.4 PLACE AND COUNTRY OF MARRIAGE/ CIVIL PARTNERSHIP:
Page 9 of 14

YES YES

NO NO

If you are married to, or are the civil partner of an Irish Citizen please complete the additional details below:

13.5 SPOUSE/CIVIL PARTNER IS AN IRISH CITIZEN BY: POST NUPTIAL HONORARY DECLARATION Your spouse or civil partner must complete the applicable Section 15A declaration at the back of this form in the presence of an approved witness on or after the date you sign the Statutory Declaration. Please supply proof of your spouses/civil partners entitlement to Irish Citizenship e.g. copy of birth certificate certified to be a true copy of the original by a notary public, commissioner for oaths, peace commissioner or solicitor BIRTH DESCENT NATURALISATION

14. REFERENCES:
14.1 Please supply three references from Irish citizens with the following details:
NAME OF REFEREE 1: REFEREES ADDRESS:

DATE OF BIRTH AND COUNTRY OF BIRTH OF REFEREE: LENGTH OF TIME REFEREE HAS KNOWN THE APPLICANT:

DAY

MONTH

YEAR

NATURE OF RELATIONSHIP WITH APPLICANT: SIGNATURE OF REFEREE:

CONTACT NUMBER OF REFEREE: NAME OF REFEREE 1: REFEREES ADDRESS:

DATE OF BIRTH AND COUNTRY OF BIRTH OF REFEREE: LENGTH OF TIME REFEREE HAS KNOWN THE APPLICANT:

DAY

MONTH

YEAR

NATURE OF RELATIONSHIP WITH APPLICANT: SIGNATURE OF REFEREE: CONTACT NUMBER OF REFEREE:

NAME OF REFEREE 1: REFEREES ADDRESS:

DATE OF BIRTH AND COUNTRY OF BIRTH OF REFEREE: LENGTH OF TIME REFEREE HAS KNOWN THE APPLICANT:

DAY

MONTH

YEAR

NATURE OF RELATIONSHIP WITH APPLICANT: SIGNATURE OF REFEREE: CONTACT NUMBER OF REFEREE:

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STATUTORY DECLARATION
FULL NAME OF APPLICANT A1

I, , 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 and by virtue of the Statutory Declarations Act 1938, as amended by the Civil Law (Miscellaneous Provisions) Act 2008. Signed:
A2

Date:

A3

NAME OF WITNESS IN CAPITALS

W1

Declared before me commissioner] [person authorised by by

NAME OF APPLICANT W2

a [notary public] [commissioner for oaths] [Solicitor] [peace

INSERT AUTHORISING STATUTORY PROVISION W2

to take and receive statutory declarations]

[who is personally known to me],

W3.0

OR
[who was identified to me by
NAME W3.1

who is personally known to me],

OR
[whose identity has been established to me before the taking of this Declaration by the production to me of:

passport no. issued on which is an authority recognised by the Irish Government

PASSPORT NUMBER

W3.21

DATE OF ISSUE

W3.21

by the authorities of

ISSUING STATE

W3.21

OR
IDENTITY CARD NUMBER W3.22 DATE OF ISSUE W3.22

national identity card no. of Agreement

ISSUING STATE W3.22

issued on

by the authorities

,which is an EU Member State, the Swiss Confederation or a Contracting Party to the EEA

OR
PASSPORT NUMBER W3.23

aliens passport no. (document equivalent to a passport) by the authorities of

ISSUING STATE W3.23

issued on

DATE OF ISSUE

W3.23

, which is an authority recognised by the Irish Government

OR
refugee travel document no. and Equality
DOCUMENT NUMBER W3.24

issued on

DATE OF ISSUE

W3.24

by the Minister for Justice

OR
travel document (other than refugee travel document) by the Minister for Justice and Equality]
DOCUMENT NUMBER W3.25

issued on

DATE OF ISSUE

W3.25

at

PLACE OF SIGNATURE

W4

this

DAY

W4

day of

MONTH AND YEAR

W4

W5

SIGNATURE OF WITNESS: NAME OF WITNESS: (CAPITALS) ADDRESS OF WITNESS:

W6

W7

W8

DAY-TIME TELEPHONE NUMBER:

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DECLARATION TO BE COMPLETED BY THE SPOUSE OF THE APPLICANT WHERE THE APPLICANT IS APPLYING FOR NATURALISATION BASED ON HIS OR HER MARRIAGE TO AN IRISH CITIZEN
I
FULL NAME OF SPOUSE OF APPLICANT DATE OF BIRTH

do solemnly and sincerely declare that I married

PLACE OF BIRTH COUNTRY OF BIRTH

NAME OF APPLICANT COUNTRY

who was born on the

DATE OF MARRIAGE

at
PLACE OF MARRIAGE

in
COUNTRY OF MARRIAGE

a national of

on the at in and that we are living together as husband and wife, that our marriage is subsisting and that no proceedings for divorce or annulment of this marriage have been commenced, or are about to be commenced in any court of law and I make this solemn declaration conscientiously believing the same to be true and by virtue of the Statutory Declarations Act 1938, as amended by the Civil Law (Miscellaneous Provisions) Act 2008. SIGNATURE OF IRISH CITIZEN: DATE OF DECLARATION: CURRENT ADDRESS:
DAY MONTH YEAR

NAME AT BIRTH IF DIFFERENT: DATE OF BIRTH AND PLACE OF BIRTH: PASSPORT NUMBER: Declared before me a [Notary Public][Commissioner for Oaths][Solicitor][Peace Commissioner] [person authorised by INSERT AUTHORISING STATUTORY PROVISION to take and receive statutory declarations] by
OR
IRISH CITIZEN SPOUSE OF APPLICANT
DAY MONTH YEAR

[who is personally known to me],

NAME

[who was identified to me by who is personally known to me], OR [whose identity has been established to me before the taking of this Declaration by the production to me of: passport no. issued on which is an authority recognised by the Irish Government
CARD NUMBER PASSPORT NUMBER W3.21 DATE OF ISSUE W3.21

by the authorities of

ISSUING STATE

W3.21

OR
DATE OF ISSUE

national identity card no. of Agreement

ISSUING STATE

issued on

by the authorities

, which is an EU Member State, the Swiss Confederation or a Contracting Party to the EEA
OR

aliens passport no. (document equivalent to a passport) by the authorities of

ISSUING STATE

PASSPORT NUMBER

issued on

DATE OF ISSUE

, which is an authority recognised by the Irish Government

OR
DATE OF ISSUE

refugee travel document no. and Equality

DOCUMENT NUMBER

issued on
OR

by the Minister for Justice

travel document (other than refugee travel document) by the Minister for Justice and Equality]

DOCUMENT NUMBER

issued on

DATE OF ISSUE

At

PLACE OF SIGNATURE

this

DAY

day of

MONTH AND YEAR

SIGNATURE OF WITNESS: NAME OF WITNESS: (CAPITALS) ADDRESS OF WITNESS: DAY-TIME TELEPHONE NUMBER:

Page 12 of 14

DECLARATION TO BE COMPLETED BY THE CIVIL PARTNER OF THE APPLICANT WHERE THE APPLICANT IS APPLYING FOR NATURALISATION BASED ON HIS OR HER BEING THE CIVIL PARTNER OF AN IRISH CITIZEN
I
FULL NAME OF CIVIL PARTNER OF APPLICANT DATE OF BIRTH

do solemnly and sincerely declare that I married

PLACE OF BIRTH COUNTRY OF BIRTH

NAME OF APPLICANT COUNTRY

who was born on the

DATE OF CIVIL PARTNERSHIP

at
NAME OF APPLICANT

in

a national of

as and from, , and I are parties to a civil partnership registration/have entered into [specify legal relationship entered into], being a legal relationship of a class that is the subject of an order made PLACE OF CIVIL PARTNERSHIP under section 5 of the Civil Partnership and Certain Rights and Obligations of Cohabitants Act 2010, at [Place of civil ip] in in COUNTRY OF CIVIL PARTNERSHIP [Country of civil partners , that we are living together as civil partners, that our civil partnership is subsisting and that no proceedings for the dissolution of, or the grant of a decree of nullity in respect of this civil partnership have been commenced, or are about to be commenced, in any court of law and I make this solemn declaration conscientiously believing the same to be true and by virtue of the Statutory Declarations Act 1938, as amended by the Civil Law (Miscellaneous Provisions) Act 2008. SIGNATURE OF IRISH CITIZEN: DATE OF DECLARATION: CURRENT ADDRESS:
DAY MONTH YEAR

NAME AT BIRTH IF DIFFERENT: DATE OF BIRTH AND PLACE OF BIRTH: PASSPORT NUMBER: This Declaration was declared & subscribed before me a [Notary Public][Commissioner for Oaths][Solicitor][Peace Commissioner] INSERT AUTHORISING STATUTORY PROVISION to take and receive statutory declarations] by
OR
IRISH CITIZEN CIVIL PARTNER OF APPLICANT
DAY MONTH YEAR

[person authorised by

[who is personally known to me],

[who was identified to me by who is personally known to me], OR [whose identity has been established to me before the taking of this Declaration by the production to me of: passport no. issued on which is an authority recognised by the Irish Government national identity card no. of Agreement
ISSUING STATE CARD NUMBER PASSPORT NUMBER W3.21 DATE OF ISSUE W3.21

NAME

by the authorities of

ISSUING STATE

W3.21

OR

issued on

DATE OF ISSUE

by the authorities

, which is an EU Member State, the Swiss Confederation or a Contracting Party to the EEA
OR

aliens passport no. (document equivalent to a passport) by the authorities of

ISSUING STATE

PASSPORT NUMBER

issued on

DATE OF ISSUE

, which is an authority recognised by the Irish Government

OR
NUMBER

refugee travel document no. DOCUMENT and Equality

issued on
OR

DATE OF ISSUE

by the Minister for Justice

travel document (other than refugee travel document) by the Minister for Justice and Equality]

DOCUMENT NUMBER

issued on

DATE OF ISSUE

At

PLACE OF SIGNATURE

this

DAY

day of

MONTH AND YEAR

SIGNATURE OF WITNESS: NAME OF WITNESS: (CAPITALS) ADDRESS OF WITNESS: DAY-TIME TELEPHONE NUMBER:
Page 13 of 14

PLEASE NOTE: IF YOU SUBMIT THE APPLICATION FORM WITHOUT ALL OF THE REQUIRED DOCUMENTATION OR IF PHOTOCOPIES OF
CERTIFICATES ARE NOT CERTIFIED AS TRUE COPIES OF THE ORIGINALS OR IF THE FORM IS NOT FULLY COMPLETED OR IF THE STATUTORY DECLARATION HAS NOT BEEN COMPLETED CORRECTLY, YOUR APPLICATION WILL BE REFUSED AS THE APPLICATION REQUIREMENTS UNDER SECTION 17 OF THE IRISH NATIONALITY AND CITIZENSHIP ACT 1956, AS AMENDED, ARE NOT SATISFIED AND YOUR APPLICATION FEE WILL NOT BE REFUNDED.

PLEASE ENSURE THAT: YOU HAVE ANSWERED ALL QUESTIONS IN THIS FORM
Please re-check your application and ensure that all questions on the form are answered. Ensure you are completing the current version of the form by downloading it from the Irish Naturalisation and Immigration Service website at www.inis.gov.ie. If the question is not applicable to you, please answer with n/a (all questions must be answered). Failure to fully complete the currently precribed form will result in your application being refused as application requirements under section 17(a) of the Irish Nationality and Citizenship Act 1956, as amended have not been satisfied.

YOU HAVE ENCLOSED ALL REQUIRED DOCUMENTATION WITH THIS FORM

Please re-check to ensure that you have all of the required documentation/certified copies of documentation available to include with your application. Failure to submit required documentation will result in your application being refused as application requirements under section 17(b)(ii).of the Irish Nationality and Citizenship Act 1956, as amended have not been satisfied.

YOU HAVE ENCLOSED THE STATUTORY APPLICATION PROCESSING FEE OF 175.

Failure to enclose the prescribed fee will result in your application being refused under Section 17(b)(i) of the Irish Nationality and Citizenship Act 1956, as amended.

ALL PHOTOCOPIES OF CERTIFICATES ARE CERTIFIED I.E. STAMPED AND SIGNED TRUE COPY OF THE ORIGINAL BY A SOLICITOR, COMMISSIONER FOR OATHS, NOTARY PUBLIC OR PEACE COMMISSIONER YOU HAVE ENCLOSED COPIES OF CERTIFIED TRANSLATIONS OF ANY DOCUMENTS WHICH ARE IN A LANGUAGE OTHER THAN ENGLISH OR IRISH THE STATUTORY DECLARATION IS COMPLETED CORRECTLY I.E. YOU HAVE WRITTEN YOUR FULL NAME IN BOX A1, SIGNED AND DATED THE FORM IN BOXES A2 AND A3 AND HAD THE DECLARATION CORRECTLY WITNESSED BY A SOLICITOR, COMMISSIONER FOR OATHS, NOTARY PUBLIC OR PEACE COMMISSIONER. IF YOU ARE APPLYING ON THE BASIS OF YOUR MARRIAGE TO OR BEING THE CIVIL PARTNER OF AN IRISH CITIZEN,
THEN THAT IRISH CITIZEN MUST HAVE COMPLETED THE APPROPRIATE DECLARATION AT THE BACK OF THE FORM AFTER YOU HAVE SIGNED THE STATUTORY DECLARATION. THE DECLARATION MUST ALSO BE WITNESSED BY A SOLICITOR, COMMISSIONER FOR OATHS, NOTARY PUBLIC OR PEACE COMMISSIONER.

PLEASE BE AWARE THAT ONLY VALID APPLICATIONS, FULLY COMPLETED WITH ALL REQUIRED SUPPORTING DOCUMENTATION AND STATUTORY APPLICATION FEE ENCLOSED, ARE ACCEPTABLE. DEFICIENT APPLICATIONS WILL BE REFUSED. THE STATUTORY APPLICATION FEE IS NON-REFUNDABLE IN ALL CASES AND MUST ACCOMPANY EVERY APPLICATION FOR A CERTIFICATE OF NATURALISATION.
PLEASE POST THE FULLY COMPLETED FORM, FEE AND ALL REQUIRED DOCUMENTATION TO:

CITIZENSHIP APPLICATIONS F8, IRISH NATURALISATION AND IMMIGRATION SERVICE, HEFFERNAN HOUSE, DUNDRUM ROAD, TIPPERARY TOWN.

Page 14 of 14