Ukm Application Form – Fill Out and Use This PDF

Form UKM

Application for registration as a British citizen by a person born before 1983 to a British mother

To be used by people in the Channel Islands, Isle of Man and British overseas territories, and by people who live elsewhere and want to apply by post.

The Home Office will use the personal information you provide to consider your application. We may also share your information with other public and private sector organisations in the UK and overseas. For more detail please see the Privacy Notice for the Border, Immigration and Citizenship system at www.gov.uk/government/publications/personal-information-use-in- borders-immigration-and-citizenship. This also sets out your rights under the Data Protection Act 2018 and explains how you can access your personal information and complain if you have concerns about how we are using it.

September 2019

Section 1 - Personal Information

Before completing this form, you should read the accompanying Guide UKM. Fill in the parts of the form which apply to your application (see section 3 in Guide UKM) and cross out all other parts. If there is not enough space for your answer, use a separate sheet of paper. Please write clearly in block capitals using black ink.

1.2Surname/family name (the name you give here will be the name shown on your certificate so please ensure it is spelt correctly and you have written it in the correct order):

1.3Other names:

1.4Name at birth if different from above. (If the names you have given are different or spelt differently from the name shown on your passport, please explain why on a separate sheet of paper):

1.5If you are or have ever been known by any name or names apart from those mentioned above, please give details here:

1.6Your present nationality:

1.7 National Insurance number:

1.9Village or town or city of birth:

1.10Country of birth:

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1.12Current marital status (please tick one box only):

1.13Present address (you must give us any change of address in writing while we are considering this application):

Postcode:

Daytime/Mobile telephone number:

Evening telephone number:

Email address:

If someone is representing you, for example an agent or solicitor, or you are making an application through a consulate, please tell us their:

1.14Name:

1.15Address:

Postcode:

1.16 Telephone number:

1.17If you have completed 1.14 and the address is that of your immigration advisor, please state their Office of the Immigration Services Commission (OISC) number:

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1.18If your application is approved, you will need to take part in a citizenship ceremony. If you are in the United Kingdom, the venue will normally be within a local authority area near where you live. If you want to have your ceremony in another area you should give us the details of the local authority location below.

Name:

Address:

Postcode:

Details of your parents

1.19Your mother’s full name:

1.20Your mother’s maiden name:

1.21Your mother’s town and country of birth:

1.22Your mother’s nationality:

State how your Mother acquired citizenship of the United Kingdom and Colonies:

If this was by registration or naturalisation, give the certificate number:

1.24Your father’s full name:

1.25Your father’s town and country of birth:

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1.26Your father’s nationality:

Details of your mother’s parents if relevant (see Guide UKM):

1.28Your grandfather’s full name:

1.29Your grandfather’s town and country of birth:

1.30Your grandfather’s nationality:

1.31Your grandfather’s date of birth: D D M M Y Y Y Y

State how your grandfather acquired British nationality:

If this was by registration or naturalisation, give the certificate number:

1.32Your grandmother’s full name:

1.33Your grandmother’s maiden name:

1.34Your grandmother’s town and country of birth:

1.35Your grandmother’s nationality:

1.36Your grandmother’s date of birth: D D M M Y Y Y Y

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State how your grandmother acquired British nationality:

If this was by registration or naturalisation, give the certificate number:

If you were settled in the United Kingdom before 1 January 1983 and had been ordinarily resident in the UK for at least 5 years, please give details:

If you are a woman who married a man with the right of abode in the United Kingdom before 1 January 1983, please give details even if you are no longer married to that man.

1.37Husband’s full name:

1.39Husband’s town and country of birth:

1.40Husband’s nationality at the time of the marriage:

If he was a citizen of the United Kingdom and Colonies, state how he acquired this status:

If by nationalisation or registration, please give the certificate number and date and place of issue:

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2.1One referee should be a person of any nationality who has professional standing, for example, minister of religion, civil servant, or a member of a professional body, for example, accountant or solicitor (who is not representing you with this application). The other referee must normally be a holder of a British citizen passport and either a professional person or over the age of 25.

Both should declare that:

•they are not a relative, solicitor or agent of the applicant

•they are not employed by the Home Office

•they have not been convicted of an imprisonable offence (unless that conviction can be disregarded in line with the table shown in the Good character section of the Nationality forms guide - www.gov.uk/government/publications/nationality-forms-guide)

•they have known the applicant personally for more than 3 years

•they are willing to give full details of their knowledge of the applicant

•they will advise the Home Office of any reason why the applicant should not be naturalised

1st Referee declaration

I declare that I am qualified to act as a referee. The photograph above is a true likeness of the applicant. I confirm each of the points in 2.1 above. I confirm that to the best of my knowledge the details given on page 2 of this form are correct.

2.2Say how you know the applicant, and state your age and profession:

1st referee full name:

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2.4Address:

Postcode:

If you have been at this address less than 3 years please list previous addresses on a separate sheet.

2.5 Daytime telephone number:

2.6Email address:

2.7Current British citizen passport number (if any):

I understand that I may be liable for prosecution resulting in a penalty of up to 3 months imprisonment or a fine not exceeding £5000 or both, if I knowingly or recklessly make a false declaration.

Signature of referee:

Date:

2nd Referee declaration

I declare that I am qualified to act as a referee. The photograph above is a true likeness of the applicant. I confirm each of the points in 2.1 above. I confirm that to the best of my knowledge the details given on page 2 of this form are correct.

2.8Say how you know the applicant, and state your age and profession:

2nd referee full name:

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2.10Address:

Postcode:

If you have been at this address less than 3 years please list previous addresses on a separate sheet.

2.11 Daytime telephone number:

2.12Email address:

2.13Current British citizen passport number (if any):

I understand that I may be liable for prosecution resulting in a penalty of up to 3 months imprisonment or a fine not exceeding £5000 or both, if I knowingly or recklessly make a false declaration.

Signature of referee		Date
		D	D	M	M	Y	Y	Y	Y

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Section 3 - Biometric enrolment

In accordance with British Nationality (General) (Amendments) (2) regulations 2014 anyone applying for naturalisation or registration as a British citizen must register their biometric information. For more information about registering your biometric information, please see the accompanying guidance notes, which you must read before completing this form.

If you have a current grant of leave on a Biometric residence permit, you must provide your Biometric residence permit for the application to be valid and complete.

3.1Have you been issued with a biometric residence permit with a previous application for leave?

Please give details of your biometric residence permit. Please note for the application to be valid and complete, your current biometric residence permit must be provided, unless it is not available for one of the reasons specified on the application form.

3.2 BRP number:

3.3Nationality:

3.7Biometric residence permit enclosed?

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3.8If the required BRP has been returned to the Home Office, please give details of the reason it was sent to us:

3.9If the BRP was lost please give the date this was reported to the Home Office card management service:

D D M M Y Y Y Y

3.10If the biometric resident permit was stolen, please give the police report number, crime reference number, the police station and the date reported to the police.

Police report number:

Crime reference number:

Police station:

Date reported to the police:

D D M M Y Y Y Y

3.11If the required BRP is not enclosed please give details why you are unable to provide it:

3.12Have you had your fingerprints taken as part of a previous UK immigration application made in the UK or abroad?

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3.13Date your fingerprints were taken:

3.14Give details where your fingerprints were taken, including the town or city and country:

3.15Give details of the British diplomatic post or posts involved if the application or applications was or were made abroad:

3.16Do you have a medical or physical condition which may require special arrangements for your biometric features to be recorded?

3.17Declaration

As required by British Nationality (General) (Amendment) (2) Regulations 2014, I confirm that I wish to register my biometric information.

Signature of applicant:

Date:

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Section 4 - Declaration by applicant

Warning: to give false information on this form knowingly or recklessly is a criminal offence punishable with up to 3 months’ imprisonment or by a fine not exceeding £5000 or both.

(Section 46(1) of the British Nationality Act 1981, as amended).

4.1 I (full name in block letters)

declare that, to the best of my knowledge and belief, the information given in this application is correct. I know of no reason why I should not be granted British citizenship. I promise to inform the Home Secretary in writing of any change in circumstances which may affect the accuracy of the information given whilst this application is being considered by the Home Office. I understand that information given by me will be treated in confidence, but may be submitted for checking against records held by other Government departments, the Security Service and other agencies, local authorities and the police, where it is necessary for immigration or nationality purposes, or to enable these bodies to carry out their functions.

I understand that I may be liable for prosecution if I have knowingly or recklessly provided false or incomplete information.

I authorise the HM Revenue and Customs to provide the Home Office with information relevant to this application, and with any information needed to check the information I have provided. I understand that any information provided to the HM Revenue and Customs in connection with this application may be used by them for the purpose of their statutory functions.

I authorise the Home Office to make enquiries of

•the Insolvency Service (England and Wales)

•the Accountant in Bankruptcy (Scotland)

•the Official Receiver (Northern Ireland)

•another appointed Receiver concerning my declaration of bankruptcy

I agree that the relevant body may disclose personal information obtained as part of their statutory function

4.2 I confirm that I have read and understood the guide to registration as a British citizen

4.3 I confirm that I have enclosed the appropriate fee and payment slip

4.4 I confirm that I have enclosed the appropriate documents

4.5I understand that a certificate of citizenship may be withdrawn if it is found to have been obtained by fraud, false representation or concealment of any material fact, or if on the basis of my conduct the Home Secretary considers it to be conducive to the public good

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Please sign below once you are satisfied that you have completed the form correctly. Your application will not be valid if you do not enclose the correct fee. Fees are not fully refundable for applications that fail. You are recommended to read the guide, particularly those sections on how to qualify.

Signature:Date:

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