English Translation

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HOME OFFICE
FORM A.I

BRITISH NATIONALITY ACT, 1948
APPLICATION BY AN ALIEN FOR A CERTIFICATE
OF NATURALISATION

The instructions accompanying this form must be read carefully before the form is completed.
Portions of the form which are not applicable should be struck out and initialled in every case.

1. Original name in full in
country of birth
(in BLOCK LETTERS)

If name at birth has been
altered, give particulars and
date of alteration

Particulars of any other name(s)
used for private purposes

Particulars of any other name(s)
used for trading or business
purposes

Private address

Occupation

Business address and/or name
and address of employers (if a
director, names and addresses
of companies concerned)

/Count/ Joseph Vincent Adalbertus Maria
William Romanus Czernin
Known as Joseph Czernin

23, Seymour Place, London, W.1.

Departmental Manager

Couper, Friend & Co.Ltd.,
33/35, Eastcheap,
London, E.C.3.

2. Country, place and date
of birth

Country
Czechoslovakia

Place
Prague

Date of birth
9th August 1924.

Nationality at birth
Czechoslovak

Present nationality if different
Stateless

State how change in nationality
was made

If stateless, say how nationality
was lost

Czechoslovak passport was not renewed

3. Father's full name in country
of his birth
(in BLOCK LETTERS)

Present address (if living)
Nationality (if dead, at time
of death)

Mother's full name before
marriage in country of her
birth (in BLOCK LETTERS)

Present address (if living)
Nationality (if dead, at time
of death)

Francis Joseph Czernin
23, Seymour Pl., London, W.1.

Vilemina Czernin
23, Seymour Pl., London, W.1.

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