退出中华人民共和国国籍申请表.doc

退出中华人民共和国国籍申请表 编号Serial No. Application for Renunciation of Chinese Nationality 一、个人信息Personal Information 1.1 中文姓名/ Chinese Name 姓/Family Name: 名/Given Name: 照片/Photo 1.2 英文姓名/ English Name Exactly As It Appears on Your Passport 姓/Family Name: 中间名/ Middle Name: 名/Given Name: 1.3 别名或曾用名/ Other Name(s) 1.4 性别/ Gender ￡ 男/Male ￡ 女/Female 1.5 出生日期/ Date of Birth (yyyy-mm-dd) 1.6 出生地（国家/城市）/ Place of Birth(City /Country) 1.7 婚姻状况/ Marital Status ￡ 未婚/ Single, Never Married ￡ 已婚/Married ￡ 离异/Divorced ￡ 丧偶/Widowed ￡ 其他（请注明）Other(Specify): 1.8 国内户口状况/ Domestic Household Registration ￡ 已登记户口/Registered Household ￡ 未登记户口/Unregistered Household ￡ 户口已注销/ Household Registration Canceled 注销时间/Date of Cancellation: 1.9 （原）户口所在地/ Place of (Former) Household Registration 1.10（原）公民身份号码/ (Former) Identity Card Number 1.11 现持中国护照/旅行证件（如有）/ Current Chinese Passport/Travel Document (if applicable) 证件种类/ Type of Document 证件号码/ Document Number 签发日期/ Date of Issue 签发国家或地区/ Place of Issue 失效日期/ Date of Expiry 1.12 电话号码/ Phone Number 1.13 电子邮箱/ E-mail 1.14 现住址/ Current Physical Address 1.15 工作单位/ Employer 二、申请信息Application Information 2.1 退籍事由/ Reasons for Renunciation of Chinese Nationality ￡ 外国人的近亲属/ Close Relative of a Foreign National ￡ 配偶/Spouse ￡ 父母/Parents ￡ 子女/Children ￡ 同胞兄弟姐妹/Siblings ￡ 定居在外国/ Have Settled Abroad 请详细说明持何证件、因何事由、定居何国、何时起定居该国/ Please specify what document you hold, for what reason and in which country you have settled, and since when you have settled in this country: ￡ 其它正当理由/ Other 具体情况/Specify: 2.2 是否为国家工作人员 或现役军人/ Are you a national employee or an active-duty military personnel？ ￡ 是/Yes ￡ 否/No 如是，请详细说明工作单位名称/ If you answered “Yes”, please specify the name of your employer: 2.3 欲加入或取得何国国籍/ What nationality will you acquire？ 2.4 是否已取得具有该国国籍的证明文件/ Have you obtained any documents to prove the nationality that you