THE UNITED REPUBLIC OF TANZANIA

________ (Section 19 (1))

The Third Schedule

DECLARATION CONCERNING CITIZENSHIP

(Under section 6 of the Constitution)

I, ……………………………………………………………………..……………………………Full name in
do solemnly and sincerely declare:- Block capitals

1. That I was born at ……………………..……………………….…………………………….

in *Tanzania / ………………………………..………………………………………………
and am of over the age of 21 years. Insert name
of country

2. That I am a citizen of Tanzania by *birth/descent/registration/naturalization and am also a

national of ………………………..…by *birth/descent/registration/naturalization/marriage. Insert name

of country
3. That as I am desirous of retaining my status as a citizen of Tanzania, I hereby renounce so far

as it lies within my power my status as a *citizen/national of ………………………........... Insert name

and any claim I have to the protection of that country. of country

………………………………..
Signature of Applicant

Declared at …………………...…………………this ………………………………..day of

………………………………….200 ……., before me.

…………………………………………….
*Magistrate/Commissioner for Oaths

*Delete in applicable.

OR

(Under sections 3,4 and 7 of the Ordinance)

I, ………………………………………………………………………………………………
Full name in
do solemnly and sincerely declare:- Block capitals
1. That I was born at …………………………………………………………………………….
and am of or over the age of 21 years. Insert name
of Country
2. That I have been granted Tanzania citizenship/by *registration/naturalization on condition
that I renounce my *citizenship/nationality of ………………………………………………
Insert name
3. I hereby renounce so far as it lies within my power my status as a *citizen/national of of Country
……………………………………………………………………and any claim I have to the
protection of that country. Insert name
of Country
………………………………....
Signature of Applicant

Declared at …………………………..this……………………….day of …………200……, before me.

….…………………..………………
*Magistrate/Commissioner for Oaths
*Delete in applicable
JAMHURI YA MUUNGANO WA TANZANIA
(Section 19 (1))
 __________

Nyongeza ya Tatu

TAMKO JUU YA URAIA

(Kwa mujibu wa Fungu 6 la Katiba)

Mimi, ………………………………………………….………………………………………….. Andika jina

Kwa dhati na kwa ukweli natamka:- kamili

1. Kwamba nimezaliwa …………………………………………………………………………….. Tia jina la

Nchi
humu Tanzania/ …………………………………………………………………………………
na mimi umri wangu ni zaidi ya miaka 21.

2. kwamba mimi ni raia wa Tanzania kwa *Kuzaliwa/ukoo/kujiandikisha/tajinisi/ndoa na vile vile

ni mwananchi wa ………………………………………………………………………………… Tia jina la

kwa *kuzaliwa /ukoo/kujiandikisha/tajinisi/ndoa. Nchi

3. Kwamba kwa kuwa nataka nibaki na uraia wangu wa Tanzania basi naukanusha kama niwe-

zavyo *uraia/uwananchi wangu wa ………………………………………………………….... Tia jina la

na sitafanya madai yoyote ya kutaka kuhifadhiwa na nchi hiyo. Nchi

………………………………………..
Sahihi ya Mwombaji

Imetamkwa hapa ……………………………………………leo tarehe ………………………..

Mwezi ……………………………………….mwaka 200 ………mbele yangu.

………………..………………………
Hakimu/Kamishna wa Viapo

*Futa lisilofaa.