1 card per individual Please fax a copy of the data page of your passport to (04) 9360562
Record ID No.
REGISTRATION CARD BRITISH CITIZENS
Surname (in block letters)
Mr Mrs Miss
Christian or given names
Maiden Name (if applicable)
Date of Registration
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2003 2004 2005
Occupation
Place of Birth
Date of Birth
Blood Group
Not listed Unknown A A+ A AB AB+ AB- B B+ B- O O+ O-
Dates of Renewals
Single Married Widowed Divorced
Religious Denomination
Not listed Unknown Anglican Armenian Orthodox Baptist Buddhist Catholic Christian Orthodox Christian Scientist Church of England Church of Irland Church of Scotland Greek Orthodox Hindu Jehovah Witness Judaism Methodist Not Declared Presbyterian Protestant Roman Catholic Russian Orthodox Shia Muslim Shinto Sunni Muslim Zen
Home Address
Tel No.
Mobile No.
Fax No.
Email
Passport No.
Place and Date of Issue
State grounds on which national status in based
Particulars of Naturalisation or Registration Certificate, From E3A, etc
Other citizenship or nationality (if any)
Next of kin or other person to be notified if necessary
Name
Address
Relationship
Name and nationality of spouse
Please complete a separate card for spouse and each child
Signature of Person Registered
When a person is registered without producing a passport particulars should be given here of the documents submitted as proof of British nationality
Reference to Correspondence
Date of Departure and Permanent forwarding Address