加入中華人民共和國國籍申請表

加入中華人民共和國國籍申請表編號SerialNo.ApplicationforNaturalizationAsaChineseNational一、個人信息PersonalInformation1.1中文姓名/ChineseName姓/FamilyName:名/GivenName:照片/Photo1.2英文姓名/EnglishNameExactlyAsItAppearsonYourPassport姓/FamilyName:中間名/MiddleName:名/GivenName:1.3別名或曾用名/OtherName(s)1.4性別/Gender￡男/Male￡女/Female1.5出生日期/DateofBirth(yyyy-mm-dd)1.6出生地（國家/城市）/PlaceofBirth(City/Country)1.7婚姻狀況/MaritalStatus￡未婚/Single,NeverMarried￡已婚/Married￡離異/Divorced￡喪偶/Widowed￡其他（請注明）Other(Specify):1.8現(xiàn)有國籍/CurrentNationality(ies)￡無國籍/Stateless￡單一國籍/SingleNationality請詳細說明具體國籍、何時因何種原因取得該國籍/Pleasespecifywhatnationalityyouacquired,andwhenandforwhatreasonyouacquiredit:￡雙重或多重國籍/DualorMultipleNationalities請詳細說明具體國籍、何時因何種原因取得該國籍/Pleasespecifywhatnationalitiesyouacquired,andwhenandforwhatreasonyouacquiredthem:1.9曾有國籍/FormerNationality(ies)請詳細說明具體國籍、何時因何種原因退出或喪失該國籍/Pleasespecifywhatnationality(ies)yourenouncedorlost,andwhenandforwhatreasonyourenouncedorlostyournationality(ies):1.10現(xiàn)持護照或旅行證件/CurrentPassport/TravelDocument證件種類/TypeofDocument證件號碼/DocumentNumber簽發(fā)日期/DateofIssue簽發(fā)國家或地區(qū)/PlaceofIssue失效日期/DateofExpiry1.11現(xiàn)持有效中國停居留證件/CurrentValidChineseVisa/StayPermit/ResidencePermit/ForeignPermanentResidentIDCard￡簽證/Visa請注明簽證號碼、有效期限至及可停留天數(shù)/Pleasespecifythevisanumber,expirydateanddurationofeachstay:￡停留居留證件/StayPermit/ResidencePermit請注明證件號碼、有效期限/Pleasespecifythepermitnumberandexpirydate:￡永久居留身份/ForeignPermanentResidentIDCard請注明證件號碼、有效期限/PleasespecifytheIDCardnumberandexpirydate:￡其他證件/Other請詳細說明證件種類、號碼、有效期限/Pleasespecifythedocumenttype,numberandexpirydate:1.12電話號碼/PhoneNumber1.13電子郵箱/E-mail1.14居留地/ResidenceinChina?。ㄗ灾螀^(qū)、直轄市）/Province(AutonomousRegion/Centrally-AdministeredMunicipality):市（自治州、盟）/City(AutonomousPrefecture/League):具體住址/CurrentPhysicalAddress:二、申請信息ApplicationInformation2.1申請入籍事由/Reason(s)forNaturalizationasaChineseNational￡中國人的近親屬/CloseRelativeofChineseNationals￡配偶/Spouse￡父母/Parents￡子女/Children￡同胞兄弟姐妹/Siblings￡定居在中國/HaveSettledinChina￡已取得永久居留資格/HaveAcquiredPermanentResidency￡其他（請注明）/Other(Specify):￡其它正當理由/Other具體情況/Specify:2.2是否已退出原國籍/Haveyourenouncedyouroriginalnationality？￡是/Yes￡否/No如是，有何相關證明文件/Ifyouanswered“Yes”,whatarethesupportingdocuments?Isthisafirst-timenaturalizationapplication￡是/Yes￡否/No如否，請詳細說明前次入籍申請時間、申請事由、受理機構/Ifyouanswered“No”,pleasespecify,thereasonfor,thedateandtheacceptingauthorityofyourpreviousnaturalizationapplication:三、近親屬情況InformationAboutYourCloseRelatives關系/Relationship姓名/Name性別/Gender出生日期/DateofBirth國籍/Nationality職業(yè)/Occupation現(xiàn)住址/CurrentPhysicalAddress3.1配偶/Spouse3.2父母/Parents3.3子女/Children3.4同胞兄弟姐妹/Siblings3.5申請人無上述近親屬的，請在下方欄目填寫申請人的法定監(jiān)護人或其他親屬，注明與申請人的關系及情況信息/Iftheapplicantdoesnothaveanyoftheabove-mentionedcloserelatives,pleaseindicateinthecolumnbelowhisorherlegalguardian(s)orotherrelatives,theirrelationshipstotheapplicantandotherinformation:關系/Relationship姓名/Name性別/Gender出生日期/DateofBirth國籍/Nationality職業(yè)/Occupation現(xiàn)住址/CurrentPhysicalAddress四、教育背景Education4.1最高學歷/HighestEducationLevelAchieved￡博士/DoctoralDegree￡碩士/Master’sDegree￡本科/Bachelor’sDegree￡專科/JuniorCollegeGraduate￡高中/SeniorMiddleSchoolGraduate￡初中/JuniorMiddleSchoolGraduate￡小學/PrimarySchoolGraduate4.2會說何種語言/LanguageSkills(conversationallevelorabove)4.3自小學以來的學習經(jīng)歷/EducationSincePrimarySchool起止日期/Period學校名稱/SchoolName學歷/學位/Diploma/Degree專業(yè)/Major從/DateFrom到/DateTo五、工作信息Employment5.1現(xiàn)職業(yè)/CurrentOccupation￡議員/MemberofParliament￡政府官員/GovernmentOfficial￡商人/Businessperson￡公司職員/CompanyEmployee￡非政府組織人員/NGOStaff￡自雇/Self-Employed￡演藝人員/Entertainer￡宗教人士/ReligiousPersonnel￡學生/Student￡軍人/MilitaryPersonnel￡工人/農(nóng)民/Industrial/AgriculturalWorker￡新聞從業(yè)人員/MediaProfessional￡退休/Retired￡無業(yè)/Unemployed￡其他（請注明）/Other(Specify):5.2現(xiàn)工作單位/CurrentEmployer5.3工作經(jīng)歷/WorkExperience起止日期/Period單位/公司名稱/EmployerName部門/職務/Department/Position從/DateFrom到/DateTo六、經(jīng)濟收入和生活保障IncomeandLivelihoodSecurity6.1是否有合法穩(wěn)定經(jīng)濟來源/Doyouhavealegalandstablesourceofincome？￡是/Yes￡否/No如是，請詳細說明經(jīng)濟來源情況/Ifyouanswered“Yes”,pleasespecifyyoursourceofincome:6.2年收入（人民幣）/AnnualIncome(CNY)6.3是否有合法穩(wěn)定住所/Doyouhaveanylegalandstableplaceofresidence？￡是/Yes￡否/No如是，請詳細說明地址、產(chǎn)權人、與產(chǎn)權人關系/Ifyouanswered“Yes”,pleasespecifytheaddress,thepropertyowner,andyourrelationshiptothepropertyowner:七、本人其他事項AdditionalInformationAboutYou7.1是否為香港特別行政區(qū)、澳門特別行政區(qū)、臺灣地區(qū)居民/AreyouaresidentofHongKongSAR,MacauSARorTaiwan？￡是/Yes￡否/No如是，請詳細說明所持證件種類、號碼/Ifyouanswered“Yes”,pleasespecifythetypeandnumberofthedocumentthatprovesyoutobearesidentofHongKongSAR,MacauSARorTaiwan:7.2是否曾因違反中國出境入境法律受過處罰/HaveyoueverbeenpunishedforviolatingtheExitandEntryAdministrationLawofthePeople’sRepublicofChina？￡是/Yes￡否/No如是，請詳細說明何時、何地、因何事受到何種處罰以及處罰機關/Ifyouanswered“Yes”,pleasespecifywhatthepenaltywas,andwhen,where,forwhatreasonthepenaltywasimposedandtheauthoritythatimposedit:7.3是HaveyoueverbeenrefusedaChinesevisa,orrefusedentryintoChina？￡是/Yes￡否/No如是，請詳細說明何時、何地、因何原因被拒絕簽發(fā)中國簽證或被拒絕進入中國/Ifyouanswered“Yes”,pleasespecifywhen,whereandforwhatreasonyouwererefusedaChinesevisaorrefusedentryintoChina:7.4是否曾被注銷中國簽證、停居留證件/HasyourChinesevisa,staypermitorresidencepermiteverbeencanceled？￡是/Yes￡否/No如是，請詳細說明何時、何地、因何原因被注銷中國簽證、停居留證件/Ifyouanswered“Yes”,pleasespecifywhen,whereandforwhatreasonyouChinesevisa,staypermitorresidencepermitwascanceled:7.5是否在中國或其他國家有犯罪記錄/DoyouhaveanycriminalrecordinChinaoranyothercountry？￡是/Yes￡否/No如是，請詳細說明犯罪罪名、作出判決的國家、判決確定日期、所判處刑罰/Ifyouanswered“Yes”,pleasespecifythecrime,thecountrywherethejudgmentwasmade,thedateofjudgmentandthepenalties:7.6是否曾以政府機構官員身份訪華/HaveyouevervisitedChinaasagovernmentofficial？￡是/Yes￡否/No如是，請詳細說明何時、以何種官員身份訪華/Ifyouanswered“Yes”,pleasespecifywhenyouvisitedChinaasagovernmentofficialandyourtitle:7.7是否（曾）在境外部隊服役/Areyouservingorhaveyoueverservedinthemilitaryabroad？￡是/Yes￡否/No如是，請詳細說明服役國家、軍銜、服役時間/Ifyouanswered“Yes”,pleasespecifythecountryofservice,rankinmilitaryandlengthofservice:7.8是否曾經(jīng)參加準軍事組織、民間警戒單位、游擊隊或叛亂組織，或曾經(jīng)是其中成員之一/Haveyoueverparticipatedin,orbeenamemberofaparamilitaryorganization,civilianvigilanceunit,guerrillaorinsurgentgroup？￡是/Yes￡否/No如是，請詳細說明所參加準軍事組織、民間警戒單位、游擊隊或叛亂組織的具體名稱、參加時間以及期限/Ifyouanswered“Yes”,pleasespecifythenameoftheparamilitaryorganization,civilianvigilanceunit,guerrillaorinsurgentgroupinwhichyouparticipated,whenyouparticipatedandforhowlong:7.9是否有嚴重精神障礙或傳染性疾病/Doyouhaveanyseriousmentaldisorderorinfectiousdisease？￡是/Yes￡否/No如是，請詳細說明患有何種疾病/Ifyouanswered“Yes”,pleasespecifywhatdisorderordiseaseyouhave:八、其他需說明事項OtherInformationtoBeExplained九、聲明及簽名DeclarationandSignature本人謹此聲明，我已閱讀并理解此表所有內(nèi)容要求，并愿就所填報信息和申請材料的真實性承擔一切法律責任。IherebydeclarethatIhavereadandunderstoodthecontentsofthisapplicationformandshallbearallthelegalconsequencesfortheauthenticityoftheinformationandmaterialsIprovide.申請人簽名:日期:Applicant’sSignatureDate(yyyy-mm-dd)注：未滿18周歲的申請人由父母或其他法定監(jiān)護人代簽/Note:Aparentorlegalguar