English Translation

Home Office Reference
C 27509

IMPORTANT NOTES

1. The details shown in column A below are those which it is proposed to insert in the Certificate of Naturalisation. Please check them very carefully and show any necessary amendments or additions in column B below. This is to ensure the accuracy of the Certificate which cannot afterwards be altered.

2. This form must be signed by the applicant and returned with the fee in the enclosed envelope to THE FINANCE OFFICER, HOME OFFICE (Fee Room), WHITEHALL, LONDON, S.W.1, before the Certificate can be prepared.

| A | B |
| --- | --- |
| Full Name | JOSEF VINCENC VOJTECH MARIA VILEN ROHAN CZERNIN KLOM JOSEPH CZERNIN |
| Address | 23, SEYMOUR PLACE, LONDON, N.1. |
| Occupation | DEPARTMENTAL MANAGER COMPANY EXECUTIVE |
| Place and Date of Birth | PRAGUE, CZECHOSLOVAKIA. 9th AUGUST, 1934. |
| Nationality | CZECHOSLOVAK. |
| Single, Married, etc. | SINGLE. |
| Name of Wife or Husband | - |
| Names and Nationalities of Parents | FRANTISEK JOSEF AND VILEMINA MARIA CZERNIN (CZECHOSLOVAK). |

Names and dates of birth of minor Children who are not citizens of the United Kingdom and Colonies, and who are to be registered as such.

I believe that the particulars as stated above are correct.

Date: 3rd January 1956.
Signature of Applicant:

FOR OFFICIAL USE ONLY

£18: - : received and credited
Vote: 5.0
Subhead: 2.2
Initials: M.D.

FEE SLIP
(107179) Wt 85764/449 10m 3/55 FJP694