加入中華人民共和國(guó)國(guó)籍申請(qǐng)表

加入中華人民共和國(guó)國(guó)籍申請(qǐng)表編號(hào)SerialNo.ApplicationforNaturalizationAsaChineseNational一、個(gè)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(guó)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(qǐng)注明）Other(Specify):1.8現(xiàn)有國(guó)籍/CurrentNationality(ies)￡無國(guó)籍/Stateless￡單一國(guó)籍/SingleNationality請(qǐng)?jiān)敿?xì)說明具體國(guó)籍、何時(shí)因何種原因取得該國(guó)籍/Pleasespecifywhatnationalityyouacquired,andwhenandforwhatreasonyouacquiredit:￡雙重或多重國(guó)籍/DualorMultipleNationalities請(qǐng)?jiān)敿?xì)說明具體國(guó)籍、何時(shí)因何種原因取得該國(guó)籍/Pleasespecifywhatnationalitiesyouacquired,andwhenandforwhatreasonyouacquiredthem:1.9曾有國(guó)籍/FormerNationality(ies)請(qǐng)?jiān)敿?xì)說明具體國(guó)籍、何時(shí)因何種原因退出或喪失該國(guó)籍/Pleasespecifywhatnationality(ies)yourenouncedorlost,andwhenandforwhatreasonyourenouncedorlostyournationality(ies):1.10現(xiàn)持護(hù)照或旅行證件/CurrentPassport/TravelDocument證件種類/TypeofDocument證件號(hào)碼/DocumentNumber簽發(fā)日期/DateofIssue簽發(fā)國(guó)家或地區(qū)/PlaceofIssue失效日期/DateofExpiry1.11現(xiàn)持有效中國(guó)停居留證件/CurrentValidChineseVisa/StayPermit/ResidencePermit/ForeignPermanentResidentIDCard￡簽證/Visa請(qǐng)注明簽證號(hào)碼、有效期限至及可停留天數(shù)/Pleasespecifythevisanumber,expirydateanddurationofeachstay:￡停留居留證件/StayPermit/ResidencePermit請(qǐng)注明證件號(hào)碼、有效期限/Pleasespecifythepermitnumberandexpirydate:￡永久居留身份/ForeignPermanentResidentIDCard請(qǐng)注明證件號(hào)碼、有效期限/PleasespecifytheIDCardnumberandexpirydate:￡其他證件/Other請(qǐng)?jiān)敿?xì)說明證件種類、號(hào)碼、有效期限/Pleasespecifythedocumenttype,numberandexpirydate:1.12電話號(hào)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(qǐng)信息ApplicationInformation2.1申請(qǐng)入籍事由/Reason(s)forNaturalizationasaChineseNational￡中國(guó)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(guó)/HaveSettledinChina￡已取得永久居留資格/HaveAcquiredPermanentResidency￡其他（請(qǐng)注明）/Other(Specify):￡其它正當(dāng)理由/Other具體情況/Specify:2.2是否已退出原國(guó)籍/Haveyourenouncedyouroriginalnationality？￡是/Yes￡否/No如是，有何相關(guān)證明文件/Ifyouanswered“Yes”,whatarethesupportingdocuments?Isthisafirst-timenaturalizationapplication￡是/Yes￡否/No如否，請(qǐng)?jiān)敿?xì)說明前次入籍申請(qǐng)時(shí)間、申請(qǐng)事由、受理機(jī)構(gòu)/Ifyouanswered“No”,pleasespecify,thereasonfor,thedateandtheacceptingauthorityofyourpreviousnaturalizationapplication:三、近親屬情況InformationAboutYourCloseRelatives關(guān)系/Relationship姓名/Name性別/Gender出生日期/DateofBirth國(guó)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(qǐng)人無上述近親屬的，請(qǐng)?jiān)谙路綑谀刻顚懮暾?qǐng)人的法定監(jiān)護(hù)人或其他親屬，注明與申請(qǐng)人的關(guān)系及情況信息/Iftheapplicantdoesnothaveanyoftheabove-mentionedcloserelatives,pleaseindicateinthecolumnbelowhisorherlegalguardian(s)orotherrelatives,theirrelationshipstotheapplicantandotherinformation:關(guān)系/Relationship姓名/Name性別/Gender出生日期/DateofBirth國(guó)籍/Nationality職業(yè)/Occupation現(xiàn)住址/CurrentPhysicalAddress四、教育背景Education4.1最高學(xué)歷/HighestEducationLevelAchieved￡博士/DoctoralDegree￡碩士/Master’sDegree￡本科/Bachelor’sDegree￡專科/JuniorCollegeGraduate￡高中/SeniorMiddleSchoolGraduate￡初中/JuniorMiddleSchoolGraduate￡小學(xué)/PrimarySchoolGraduate4.2會(huì)說何種語(yǔ)言/LanguageSkills(conversationallevelorabove)4.3自小學(xué)以來的學(xué)習(xí)經(jīng)歷/EducationSincePrimarySchool起止日期/Period學(xué)校名稱/SchoolName學(xué)歷/學(xué)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(xué)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(qǐng)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(wù)/Department/Position從/DateFrom到/DateTo六、經(jīng)濟(jì)收入和生活保障IncomeandLivelihoodSecurity6.1是否有合法穩(wěn)定經(jīng)濟(jì)來源/Doyouhavealegalandstablesourceofincome？￡是/Yes￡否/No如是，請(qǐng)?jiān)敿?xì)說明經(jīng)濟(jì)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(qǐng)?jiān)敿?xì)說明地址、產(chǎn)權(quán)人、與產(chǎn)權(quán)人關(guān)系/Ifyouanswered“Yes”,pleasespecifytheaddress,thepropertyowner,andyourrelationshiptothepropertyowner:七、本人其他事項(xiàng)AdditionalInformationAboutYou7.1是否為香港特別行政區(qū)、澳門特別行政區(qū)、臺(tái)灣地區(qū)居民/AreyouaresidentofHongKongSAR,MacauSARorTaiwan？￡是/Yes￡否/No如是，請(qǐng)?jiān)敿?xì)說明所持證件種類、號(hào)碼/Ifyouanswered“Yes”,pleasespecifythetypeandnumberofthedocumentthatprovesyoutobearesidentofHongKongSAR,MacauSARorTaiwan:7.2是否曾因違反中國(guó)出境入境法律受過處罰/HaveyoueverbeenpunishedforviolatingtheExitandEntryAdministrationLawofthePeople’sRepublicofChina？￡是/Yes￡否/No如是，請(qǐng)?jiān)敿?xì)說明何時(shí)、何地、因何事受到何種處罰以及處罰機(jī)關(guān)/Ifyouanswered“Yes”,pleasespecifywhatthepenaltywas,andwhen,where,forwhatreasonthepenaltywasimposedandtheauthoritythatimposedit:7.3是HaveyoueverbeenrefusedaChinesevisa,orrefusedentryintoChina？￡是/Yes￡否/No如是，請(qǐng)?jiān)敿?xì)說明何時(shí)、何地、因何原因被拒絕簽發(fā)中國(guó)簽證或被拒絕進(jìn)入中國(guó)/Ifyouanswered“Yes”,pleasespecifywhen,whereandforwhatreasonyouwererefusedaChinesevisaorrefusedentryintoChina:7.4是否曾被注銷中國(guó)簽證、停居留證件/HasyourChinesevisa,staypermitorresidencepermiteverbeencanceled？￡是/Yes￡否/No如是，請(qǐng)?jiān)敿?xì)說明何時(shí)、何地、因何原因被注銷中國(guó)簽證、停居留證件/Ifyouanswered“Yes”,pleasespecifywhen,whereandforwhatreasonyouChinesevisa,staypermitorresidencepermitwascanceled:7.5是否在中國(guó)或其他國(guó)家有犯罪記錄/DoyouhaveanycriminalrecordinChinaoranyothercountry？￡是/Yes￡否/No如是，請(qǐng)?jiān)敿?xì)說明犯罪罪名、作出判決的國(guó)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(jī)構(gòu)官員身份訪華/HaveyouevervisitedChinaasagovernmentofficial？￡是/Yes￡否/No如是，請(qǐng)?jiān)敿?xì)說明何時(shí)、以何種官員身份訪華/Ifyouanswered“Yes”,pleasespecifywhenyouvisitedChinaasagovernmentofficialandyourtitle:7.7是否（曾）在境外部隊(duì)服役/Areyouservingorhaveyoueverservedinthemilitaryabroad？￡是/Yes￡否/No如是，請(qǐng)?jiān)敿?xì)說明服役國(guó)家、軍銜、服役時(shí)間/Ifyouanswered“Yes”,pleasespecifythecountryofservice,rankinmilitaryandlengthofservice:7.8是否曾經(jīng)參加準(zhǔn)軍事組織、民間警戒單位、游擊隊(duì)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(qǐng)?jiān)敿?xì)說明所參加準(zhǔn)軍事組織、民間警戒單位、游擊隊(duì)或叛亂組織的具體名稱、參加時(shí)間以及期限/Ifyouanswered“Yes”,pleasespecifythenameoftheparamilitaryorganization,civilianvigilanceunit,guerrillaorinsurgentgroupinwhichyouparticipated,whenyouparticipatedandforhowlong:7.9是否有嚴(yán)重精神障礙或傳染性疾病/Doyouhaveanyseriousmentaldisorderorinfectiousdisease？￡是/Yes￡否/No如是，請(qǐng)?jiān)敿?xì)說明患有何種疾病/Ifyouanswered“Yes”,pleasespecifywhatdisorderordiseaseyouhave:八、其他需說明事項(xiàng)OtherInformationtoBeExplained九、聲明及簽名DeclarationandSignature本人謹(jǐn)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(bào)信息和申請(qǐng)材料的真實(shí)性承擔(dān)一切法律責(zé)任。IherebydeclarethatIhavereadandunderstoodthecontentsofthisapplicationformandshallbearallthelegalconsequencesfortheauthenticityoftheinformationandmaterialsIprovide.申請(qǐng)人簽名:日期:Applicant’sSignatureDate(yyyy-mm-dd)注：未滿18周歲的申請(qǐng)人由父母或其他法定監(jiān)護(hù)人代簽/Note:Aparentorlegalguar