酒话醉人心W—3表
人员编号______________
档案编号______________
恢复中华人民共和国国籍
申请表
申请人____________________申请日期_______年____月____日
受理人____________________受理日期_______年____月____日
外文名___________________________________________________
中文姓名__________________国籍____________性别___________
出生日期________年______月______日出生地_____________
护照证件种类__________________ 号码_____________________
有效期至________年______月______日签发机关___________________________
所持签证种类__________________号码_________________ 签发机关__________
签证有效期___年___月___日本次入境日期___年___月___日入境口岸_________
定居确认表号码______________________ 签发日期__________________________
外国人居留证号码____________ 有效期______年____月____日职业或身份_____
定居地住址_____________所属公安派出所________________联系电话__________
申请恢复中国国籍的理由__________________________________________________
申请人简历____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
国外亲属情况
姓名性别国籍住址电话与申请人的关系
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
在华亲属情况
姓名性别国籍住址电话与申请人的关系
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 我谨声明我已如实和完整地填写了上述内容并对此负责。我自愿放弃现有国籍，申请恢复中华人民共和国国籍。
申请人签名__________________ 申请日期__________________
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