UK Visas
& Immigration

UK Visas and Immigration
Department 55
Reporting Centre
Ground Floor
Union Street
Liverpool
L3 9PP

## Tel:

Please refer to www.gov.uk/contact-ukvi-inside-
outside-uk

Web: www.gov.uk/uk-visas-immigration

| Ref:    | 033972218     |
|-|-|
| Date:   | 04 March 2024 |

## DECLARATION OF RENUNCIATION

This declaration, if signed and sealed, is formal evidence of renunciation of the nationality indicated below by:

- Document fields visible:
  - Name: [redacted/black box]
  - Date of Birth: [redacted/black box]
- Embossed seal (right side): "HOME OFFICE LONDON" with UK royal coat of arms (embossed).
- Context note (from provided text): Place and Country of Birth — Johannesburg, South Africa.

Place and Country of Birth: Johannesburg, South Africa

Nationality : British Citizen

The declaration is registered on the understanding that the person named holds another nationality or citizenship or expects to acquire another nationality or citizenship within six months of the date of renunciation. If another nationality or citizenship is not held or is not acquired within six months, this renunciation will not take effect and the person named will be considered to have retained the British nationality (or nationalities) indicated above.

EFTA00037130