1 Application for naturalization pursuant to Article 116 (2) of the Basic Law AK (GG) for the Federal Republic of y - for persons under 16 years - 1 Data concerning the child (applicant) (Provide more detailed or additional information, if necessary, on a separate sheet.) 1.1 Family name: 1.2 Name at birth: - if different from the family name Given name(s): - Enter all given names, please Date of birth: 1.5 Place or administrative district: Sex: female male 1.6 Country of birth: 1.7 Descent: the child is a natural child of his/her parents this child was adopted... Please, append relevant certificates / documentary evidence. by both parents by the father by the mother 1.8 The child s current citizenship(s): Please, enter all citizenships of the child. Citizenship Date of acquisition Basis for acquisition (e.g. descent, naturalization) 1.9 Current address: - incl. postal code if applicable Country of residence: 2 1. Holder of rights of custody (e.g. mother) 2. Holder of rights of custody (e.g. father) 2.1 Family name: - name at birth, if different from family name Forename(s): - Enter all forenames, please Current address: - if different from the applicant s address Telephone number: - including the international dialling code The right of custody results from:
2 3 Other members of the child s family have already been naturalized Please, append a copy of the certificate(s), if possible. yes A naturalization process has already been carried out for the following family members: Name (in the certificate of naturalization) Name of administration having issued the certificate Certificate dated: Reference number specified in the certificate of naturalization The child s residence periods since birth outside his/her current home country - residence of less than 6 months - (Provide more detailed or additional information, if necessary, on a separate sheet.) from to City, town, or village Country The child resided in y himself/herself: yes 5.1 Period: last place of residence in y: from to Date of registration of emigration / date of emigration Please, provide the complete address (street, house number, post code, city/town/village): 6 The child s identity document, if any Valid identity document 6.1 passport other: type of document or personal ID number identity document / ID card Please, append a certified copy of the document.
3 7 Information on the child s parents Father Mother 7.1 Family name: Name at birth and/or 7.2 former names: 7.3 Given name(s): - Enter all given names, please Date of birth: 7.5 Place of birth, administrative district, country: 7.6. Religious affiliation: Jewish other/ne Jewish other/ne 7.7 Descent: is a natural child is an adopted child is a natural child is an adopted child Date of acquisition Date of acquisition Israeli Israeli 7.8 Citizenship (current/last citizenship): other: other: from to from to 7.9 (former) citizenship: other: other: 7.10 Marriage: the parents marriage to each other The parents were married. Place of marriage from... (date of marriage) to (date) yes from to from to 7.11 previous/later marriages never resided in y never resided in y 7.12 last place of residence in y: yes Name of the city/town/village left y on: yes Name of the city/town/village left y on: 7.13 deceased: yes deceased on (date) yes deceased on (date) The parents places of residence since birth - residence of less than 6 months - (Provide more detailed or additional information, if necessary, on a separate sheet.) Father Mother from to in (town/country) from to in (town/country) 7.14
4 8 The child s naturalization claim pursuant to Article 116 (2) of the Basic Law (GG) is derived from the grandparents or from a previous generation. 8.1 yes Please, fill in Annex VA for each further generation and submit it with the application or The information on the child s ancestors are already provided in the following application: 8.2 Family name Date of birth Given name Reference number of the file processed or kept at or of the certificate of naturalization issued by the Federal Office of Administration Power of attorney A power of attorney has been given. I/we wish that any correspondence is made via the person holding the power of attorney. Please fill in ANNEX VOLLMACHT. No power of attorney has been given. the 1 st holder of rights of custody or Please, make any correspondence via... the 2 nd holder of rights of custody 10 Statements I/we apply for the naturalization of the above-mentioned mir child as a national and assure that the information I/we have provided is complete and correct. I/we have taken tice that the naturalization may be revoked if any false statements have been made. I/we must inform immediately of any changes in the personal circumstances (name, address, marital status, etc.) as well as of any other information on the child provided in the application. For information on your rights within the context of processing personal data pursuant to Articles 13 and 14 of the EU General Data Protection Regulation (GDPR), please visit the website of the Federal Office of Administration (BVA) > Staatsangehörigkeitsverfahren in Bundeszuständigkeit (in general) and the pages providing further information on the respective procedure. The Data Protection Officer s contact details are also provided there Declaration with respect to the consultation of further documents The application of the above-mentioned mir child will be processed by the Federal Office of Administration. I/we agree that the Federal Office of Administration consults further documents for processing this application provided that this is necessary. These documents may include, for instance, files on restitution or on compensation, kept at the competent authorities. I/we agree I/we do t agree Signature on behalf of the child 1 st holder of rights of custody Signature on behalf of the child 2 nd holder of rights of custody 10.2 Place and date: Place and date: Annexes: Annex Vollmacht Annex VA Number: further annexes:
5 Hinweise der Auslandsvertretung Alle in Kopie beigefügten Unterlagen haben der Auslandsvertretung vorgelegen im Original in beglaubigter Kopie als einfache Kopie Die Echtheit der Personenstandsurkunden wird belegt/bestätigt durch Haager Apostille. durch Legalisation. da von Echtheitsbestätigung befreit (CIEC-Abkommen Nr. 16 v oder bilaterale Abkommen). Die Echtheit der Personenstandsurkunden kann nicht belegt/bestätigt werden, da die Haager Apostille fehlt. die Legalisationsvoraussetzungen im Land grundsätzlich nicht vorliegen. Zweifel an der Echtheit/inhaltlichen Richtigkeit bestehen (ggf. ergänzen). Anmerkungen: Ort, Datum, Unterschrift und Stempel/Siegel