S.I. No. 569/2011 - Irish Nationality and Citizenship Regulations 2011.

1. 13 Your Person Identity Number:..............

2. 8 PPS number:..............

(If a personal public service number has been allocated to your child)

3. 5 Mobile number:..............

4. Previous addresses (parent/guardian and minor)

Please provide details 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.................

5. 6 Has your child been resident in the State since birth? Yes / No

If no, please give details of all periods of non-residence

From........... To.............. Country.................... Reason......................

6. 2 If you answered "No" to question 6.1 please indicate your intended country of residence following naturalisation:........................

7. 1 Please give details of your mother and father as follows

Name................. Birth last name............... Date of birth........... Place and country of birth.............. Present nationality...................

8. 5 Details of your employment(

s

), if any, in the past 5 years

Date From:. Date To:.. Role: Employer:...

9. 6 Application reference number:..............

10. 11 Have you engaged in any other activities that might indicate that you may not be considered a person of good character? Yes / No

If you answered ‘Yes’ to any of the questions 10.6 to 10.11 please provide details in the additional details section below. You may also use this section to give details in relation to questions 10.1 — 10.5.

Additional Details

..............

11. 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...................

Nature of relationship with applicant

Signature of referee.............. Contact number of referee.....................

Name of referee 2.............. Referees address................. Date of birth and country of birth of referee............... Length of time referee has known the applicant...................

Nature of relationship with applicant

Signature of referee............... Contact number of referee.....................

Name of referee 3.............. Referees address................. Date of birth and country of birth of referee............... Length of time referee has known the applicant...................

Nature of relationship with applicant

Signature of referee.............. Contact number of referee.....................

STATUTORY DECLARATION

I,...............................[

Full name of applicant

], 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 provisions of the

Statutory Declarations Act, 1938

, as amended by the

Civil Law (Miscellaneous Provisions) Act 2008

.

Signed:................................................................................ Date:........................

Declared before me..........[

name of witness in capitals

] a [notary public] [commissioner for oaths] [peace commissioner] [solicitor] [person authorised by................ [

insert authorising statutory provision

] to take and receive statutory declarations] by.............[

name of applicant

]

[who is personally known to me]

Or [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. . [

passport number

] issued on [

date of issue

] by the authorities of . [

issuing state

], which is an authority recognised by the Irish Government

Or national identity card no. ..[

identity card number

] issued on [

date of issue

] by the authorities of [

issuing state

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

Or aliens passport no. (

document equivalent to a passport

) ..[

passport number

] issued on .[

date of issue

] by the authorities of ..[

issuing state

],which is an authority recognised by the Irish Government

Or refugee travel document no. ..[

document number

] issued on [

date of issue

] by the Minister for Justice and Equality

Or travel document (other than refugee travel document) [

document number

] issued on [

date of issue

] by the Minister for Justice and Equality].

At.....................................[

place of signature

] this........day of.........[

date

]

Signature of witness:..............

Name of witness: (capitals)..............

Address of witness:..............

Day-time telephone number:..............

FORM 12

IRISH NATIONALITY AND CITIZENSHIP ACT 1956

NOTICE OF INTENTION TO REVOKE A CERTIFICATE OF NATURALISATION

To:.

.......................................................... [

name of person to whom the notice is addressed

]

.............. [

address

]

The Minister for Justice and Equality granted to you a Certificate of Naturalisation Number........., dated.................., on foot of your application for naturalisation as an Irish citizen dated...

Under

section 19

of the

Irish Nationality and Citizenship Act 1956

the Minister may revoke a certificate of naturalisation if satisfied that any of the conditions prescribed in

section 19

(1) apply.

The Minister intends, three months after the date of this notice, to revoke your certificate of naturalisation, being satisfied that the following condition applies

[the issue of the certificate was procured by fraud, misrepresentation whether innocent or fraudulent, or concealment of material facts or circumstances,]

OR

[you have, by overt act, shown yourself to have failed in your duty of fidelity to the nation and loyalty to the State,]

OR

[not being of Irish descent or associations, you have been ordinarily resident outside the State or, in the case of an application for a certificate of naturalisation granted under section 15A, resident outside the island of Ireland (otherwise than in the public service) for a continuous period of seven years and without reasonable excuse have not during that period registered annually in the prescribed manner your name and a declaration of your intention to retain Irish citizenship with an Irish diplomatic mission or consular office or with the Minister,]

OR

[you are also, under the law of a country at war with the State, a citizen of that country,]

OR

[you have by any voluntary act other than marriage acquired another citizenship.]

Grounds:..............

Right to apply for an enquiry

You have the right to apply to the Minister for an inquiry under

Section 19

(2) of the

Irish Nationality and Citizenship Act 1956

, as amended, as to the reasons for the intention to revoke set out above in this notice and, should you do so, the Minister will not revoke your Certificate of Naturalisation without first considering the report of the Committee of Inquiry.

The Irish Nationality and Citizenship Regulations, 2011,

S.I. No. 569 of 2011

, provide, see Regulation 11(2)

, that an application for such an inquiry shall be made by letter left with, or sent by registered post to, The Secretary General, Department of Justice and Equality, Dublin.

If you apply to the Minister for an inquiry as to the reasons for the Intention to Revoke your Certificate of Naturalisation in the manner set out above, then the Minister will, under Section 19(3) of the 1956 Act, refer your case to a Committee of Inquiry appointed by the Minister, consisting of a chairman having judicial experience and such other persons as the Minister may think fit. If a Committee of Inquiry is appointed, it will report its findings to the Minister.

Yours sincerely,

............... [Name of Official]

.............. [Date]

FORM 13

IRISH NATIONALITY AND CITIZENSHIP ACT 1956

DECLARATION OF ALIENAGE BY A PERSON OF FULL AGE

I,..............[

Name in full

] of.............................................[

Place of ordinary Residence

],

being of full age/being aged 18 years and upwards, am the person to whom the under-mentioned particulars relate.

I am about to become a citizen of............................................................................... and for that reason desire to renounce my Irish citizenship.

Signature..............

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

Declared and subscribed before me...............[

name in capitals

] a* ..[

insert qualification

] by.......[

name of applicant

]

[who is personally known to me]

Or [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. . [

passport number

] issued on [

date of issue

] by the Irish State

At.....................................[

place of signature

] this........day of.........[

date

]

Signature of witness:..............

Name of witness: (

capitals

)..............

Address of witness:..............

Day-time telephone number:..............

PARTICULARS RELATING TO DECLARANT.

Date of birth..............

Place of birth...............

Whether single/married/widow/widower/civil partner..............

If a naturalised citizen, the date of issue of the certificate of naturalisation..............

The Minister for Public Expenditure and Reform consents to the making of the foregoing Regulations.

GIVEN under my Official Seal,

9 November 2011.

BRENDAN HOWLIN,

Minister for Public Expenditure and Reform.

GIVEN under my Official Seal,

9 November 2011.

ALAN SHATTER,

Minister for Justice and Equality.

EXPLANATORY NOTE

(This note is not part of the Instrument and does not purport to be a legal interpretation.)

The Regulations prescribe the procedure to be followed and the forms to be used by persons who make declarations for the purposes of the

Irish Nationality and Citizenship Act 1956

, as amended, or who apply for certificates of naturalisation. They also prescribe the form of certificates of naturalisation which the Minister may grant, the form of notice of intention to revoke a certificate of naturalisation and the form of notice in

Irish Oifigiúil

of the grant of a certificate of naturalisation.

Form 1: *delete as appropriate: **A declaration under section 6(5) of the Act

Form 5: *A declaration under section 19(1)(c) of the Act

Form 13: *A declaration under section 21(1) of the Act

shall

(a) if made in the territory of the State, be made before any of the following persons

(i) a notary public,

(ii) a commissioner for oaths,

(iii) a peace commissioner,

(ix) a minister of religion stating his or her denomination and address of place of worship,

(v) a member of Dáil Éireann or Seanad Éireann or a member of the European Parliament for a constituency within the State,

(vi) a member of a local authority for the purpose of the

Local Government Act 2001

(No. 37 of 2001),

(vii) a barrister or solicitor,

(viii) a registered medical practitioner for the purpose of the Medical Practitioners Acts 1978 to 2002,

(ix) a qualified teacher who is a member of the teaching staff of a primary or secondary school or a third level institution

and

(b) if made elsewhere, be made before any of the following persons

(i) a person to whom

section 5

of the

Diplomatic and Consular Officers (Provision of Services) Act 1993

(No. 33 of 1993) applies, namely, the head of an Irish diplomatic mission, a member of the diplomatic staff of an Irish diplomatic mission a career consular officer of Ireland and an honorary consular officer appointed by the Minister for Foreign Affairs,

(ii) a notary public, or

(iii) any person who is, by the law of the country in which the declaration is made, a commissioner for oaths or other person authorised to take affidavits and for that purpose to administer oaths.

12. 1 If your application is based on your Irish descent or Irish associations, please give details below

Details:..............

13 Application based on marriage to or civil partnership with an Irish citizen

13. 5 Spouse/civil partner is an Irish citizen by

Birth / Descent / Naturalisation / Post nuptial declaration / Honorary

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.

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..............

Nature of relationship with applicant

Signature of referee...................... Contact number of referee.....................

Name of referee 2.............. Referees address................. Date of birth and country of birth of referee............... Length of time referee has known the applicant................................

Nature of relationship with applicant

Signature of referee.............. Contact number of referee.....................

Name of referee 3.............. Referees address................. Date of birth and country of birth of referee............... Length of time referee has known the applicant.................................

Nature of relationship with applicant

Signature of referee.............. Contact number of referee.....................

STATUTORY DECLARATION

I,......................................[

full name of applicant

], 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 provisions of the

Statutory Declarations Act 1938

, as amended by the

Civil Law (Miscellaneous Provisions) Act 2008

.

Signed:..................................................... Date:......................................................

Declared before me..........[

name of witness in capitals

] a [notary public] [commissioner for oaths] [solicitor] [peace commissioner] [person authorised by................ [

insert authorising statutory provision

] to take and receive statutory declarations] by.............[

name of applicant

]

[who is personally known to me]

Or [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. . [

passport number

] issued on [

date of issue

] by the authorities of . [

issuing state

], which is an authority recognised by the Irish Government

Or national identity card no. ..[

identity card number

] issued on [

date of issue

] by the authorities of [

issuing state

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

Or aliens passport no. (document equivalent to a passport) ..[

passport number

] issued on .[

date of issue

] by the authorities of ..[

issuing state

],which is an authority recognised by the Irish government

Or refugee travel document no. ..[

document number

] issued on [

date of issue

] by the Minister for Justice and Equality

Or travel document (other than refugee travel document) [

document number

] issued on [

date of issue

] by the Minister for Justice and Equality].

At..............[

place of signature

] this......day of..................[

date

]

Signature of witness:..............

Name of witness: (

capitals

)..............

Address of witness:..............

Day-time telephone number:..............

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

] do solemnly and sincerely declare that I married [

Name of applicant

] who was born on the [

Date of Birth

] at [

Place of birth

]in [

Country of birth

] a national of [

Country

] on the [

Date of marriage

] at [

Place of marriage

] in [

Country of marriage

], that we are living together as husband and wife, that our marriage is subsisting and that no proceedings for divorce or annulment or dissolution 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:..............

Name at birth if different:..............

Date of birth and place of birth:..............

Passport number:..............

Declared before me .................................[

name of witness in capitals

] a

[notary public

] [

commissioner for oaths

] [

peace commissioner

] [

solicitor

] [person authorised by............................[

insert authorising statutory provision

] to take and receive statutory declarations] by.........................[

Irish citizen spouse of applicant

]

[who is personally known to me]

Or [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. . [

passport number

] issued on [

date of issue

] by the authorities of . [

issuing state

], which is an authority recognised by the Irish Government

Or national identity card no. ..[

identity card number

] issued on [

date of issue

] by the authorities of [

issuing state

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

Or aliens passport no. (document equivalent to a passport) ..[

passport number

] issued on

.[

date of issue

] by the authorities of ..[

issuing state

],which is an authority recognised by the Irish Government

Or refugee travel document no. ..[

document number

] issued on [

date of issue

] by the Minister for Justice and Equality

Or travel document (other than refugee travel document) [

document number

] issued on [

date of issue

] by the Minister for Justice and Equality].

At..............[

place of signature

] this........day of.........[

date

]

Signature of witness:..............

Name of witness: (capitals)..............

Address of witness:..............

Day-time telephone number:..............

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 [

Name of civil partner of applicant

] do solemnly and sincerely declare that I am the civil partner of [

Name of applicant

] who was born on the [

Date of Birth

] at [

Place of birth

]in [

Country of birth

] a national of [

Country

], as and from [

Date of civil partnership

],[

Name of applicant

] 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 under

section 5

of the

Civil Partnership and Certain Rights and Obligations of Cohabitants Act 2010

, at [

Place of civil partnership

] in [

Country of civil partnership

], 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:..............

Name at birth if different:..............

Date of birth and place of birth:..............

Passport number:..............

Declared before me......................................[

name of witness in capitals

] a [

notary public

] [

commissioner for oaths

] [

peace commissioner

] [

solicitor

] [person authorised by .......................... [

insert authorising statutory provision

] to take and receive statutory declarations] by ....................... [

Irish citizen civil partner of applicant

] [who is personally known to me]

Or [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. . [

passport number

] issued on [

date of issue

] by the authorities of . [

issuing state

], which is an authority recognised by the Irish Government

Or national identity card no. ..[

identity card number

] issued on [

date of issue

] by the authorities of [

issuing state

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

Or aliens passport no. (

document equivalent to a passport

) ..[

passport number

] issued on.[

date of issue

] by the authorities of ..[

issuing state

],which is an authority recognised by the Irish Government

Or refugee travel document no. ..[

document number

] issued on [

date of issue

] by the Minister for Justice and Equality

Or travel document (other than refugee travel document) [

document number

] issued on [

date of issue

] by the Minister for Justice and Equality].

At..............[

place of signature

] this........day of.........[

date

]

Signature of witness:..............

Name of witness: (capitals)..............

Address of witness:..............

Day-time telephone number:..............

FORM 9

IRISH NATIONALITY AND CITIZENSHIP ACT 1956

APPLICATION FOR A CERTIFICATE OF NATURALISATION BY A NATURALISED IRISH CITIZEN ACTING ON BEHALF OF HIS/HER CHILD WHO IS NOT OF FULL AGE

Notice of the making of this Statutory Instrument was published in

“Iris Oifigiúil” of

11

th November

, 2011.

I, ALAN SHATTER, Minister for Justice and Equality, in exercise of the powers conferred on me by

section 3

of the

Irish Nationality and Citizenship Act 1956

(No. 26 of 1956) (as adapted by the Justice and Law Reform (Alteration of Name of Department and Title of Minister Order 2011 (

S.I. No. 138 of 2011

)), with the consent of the Minister for Public Expenditure and Reform, hereby make the following regulations