GENERALNI KONZULAT REPUBLIKE HRVATSKE U AUCKLANDU CONSULATE GENERAL OF THE REPUBLIC OF CROATIA IN AUCKLAND

Primljeno: Application date: Broj: Application No: Pristojba: Consular fee: Prilozi: Documents attached:

Obrazac popuniti itljivo Please fill out the form legibly Za tonost podataka odgovara podnositelj zahtjeva The applicant accepts the full responsibility for the accuracy of the data

ZAHTJEV ZA STJECANJE HRVATSKOG DRAVLJANSTVA APPLICATION FOR CROATIAN CITIZENSHIP

Kod podnoenja zahtjeva za stjecanje hrvatskog dravljanstva oznaiti odgovarajue upisivanjem znaka (x) u slobodnom polju s desne strane tabele:

B Temeljem roenja u Republici Hrvatskoj D Temeljem iseljenja iz Republike Hrvatske ili braka sa hrvatskim iseljenikom koji je E F G H I

stekao hrvatsko dravljanstvo Temeljem prethodnog miljenja nadlenog ministarstva Temeljem dravljanstva roditelja koji su priroenjem stekli hrvatsko Dravljanstvo (samo za maloljetne osobe koje zahtjev temelje na odredbi lanka 13. Zakona o hrvatskom dravljanstvu) Temeljem posvojenja s roditeljskim uinkom Ponovno stjecanje hrvatskog dravljanstva (nakon prestanka hrvatskog dravljanstva otpustom) Temeljem pripadnosti hrvatskom narodu

Please indicate the legal base for your Croatian citizenship application with a sign (x) in the appropriate empty space on the right side of the table:

B Birth on the territory of the Republic of Croatia (Article 9 of the Law on Croatian
Citizenship)

D Being a Croatian emigrant, his or her descendant or married to an emigrant who acquired the E F G H I
Croatian citizenship (Article 11 of the Law on Croatian Citizenship) Positive opinion of the relevant Croatian Ministry (on the existence of an interest in the admission to Croatian citizenship of a foreigner, Article 12 of the Law on Croatian Citizenship) Article 13 of the Law on Croatian Citizenship (a minor shall acquire Croatian citizenship by naturalization if both parents acquire citizenship by naturalization) Adoption by a Croatian citizen, with the parental legal effect (Article 14 of the Law on Croatian Citizenship) Regaining of the Croatian citizenship after it has been revoked (Article 15 of the Law on Croatian Citizenship) Being a member of the Croatian people who does not have a place of residence in the Republic of Croatia (Article 16 of the Law on Croatian Citizenship)

UPITNIK UZ ZAHTJEV ZA STJECANJE HRVATSKOG DRAVLJANSTVA QUESTIONNAIRE WITH THE APPLICATION FOR CROATIAN CITIZENSHIP
1 2 3 4 Prezime Surname(s) / family name(s) Ime Given name(s) Roeno prezime Surname / family name at birth OTAC ime i prezime FATHER given name(s), surname(s) Datum, mjesto i drava roenja Date, place and country of birth MAJKA ime, prezime i MOTHER djevojako prezime given name(s), surname(s) and maiden name Datum, mjesto i drava roenja Date, place and country of birth Popunjavaju potomci hrvatskih iseljenika iji otac ili majka nemaju hrvatsko dravljanstvo To be filled by the descendants of the Croatian emigrants when their mother or father do not have the Croatian citizenship oev/paternal Oznaiti (samo) jednu osobu za koju djed / grandfather se prilau dokazi o posjedovanju hrvatskog dravljanstva majin/maternal Please indicate (only) one ancestor oeva/paternal whose documents proving Croatian citizenship are enclosed with this baka / grandmother majina/maternal Application Ime i prezime hrvatskog pretka (ako to nije ni jedan od roditelja),za udane ene i djevojako prezime Given name(s) and surname(s) of the Croatian ancestor (if neither of your parents is Croatian), including the maiden name for married women Datum i mjesto roenja u Hrvatskoj Date and place of birth in Croatia 5 6 7 8 9 Spol podnositelja (podnositeljice) zahtjeva / sex of the applicant Dan, mjesec i godina roenja Date, month and year of birth Mjesto i drava roenja Place and country of birth Nacionalnost Nationality ZANIMANJE I zanimanje occupation PODACI O POSLODAVCU naziv poslodavca name of the employer OCCUPATION sjedite poslodavca AND THE employers address EMPLOYERS broj telefona na poslu DETAILS telephone number at work Dravljanstvo i mjesto upisa u knjigu dravljana Citizenship and place the place of citizenship registration Prijanje dravljanstvo / previous citizenship

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M/M

/F

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15

16

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grad city predgrae suburb MJESTO I DRUGI ulica i kuni br. PODACI SADANJEG street BORAVKA drava country kuni telefon CURRENT RESIDENCE home telephone DETAILS mobilni telefon mobile telephone elektronska pota e-mail address Mjesto i adresa posljednjeg prebivalita u Hrvatskoj Full address of the last known place of the (family) residence in Croatia Da li je sluio vojsku, koju, kada i gdje (in) Did you undergo any military service, if yes, state where, when and the military rank odvojen (a) /separated Brano stanje neoenjen neudana / single Marital status oenjen udana / married udovac udovica /widow (er) razveden (a) / divorced ostalo /other Datum i mjesto sklapanja braka Date and place of celebrating marriage ime i prezime branog druga BRANI i djevojako prezime za ene given name(s) and surname(s) DRUG including maiden name for women SPOUSE datum, mjesto i drava roenja date, place and country of birth dravljanstvo branog druga citizenship of the spouse Ime i prezime, datum, mjesto i drava roenja maloljetne djece obuhvaeni zahtjevom Name, surname, date, place and country of birth of the children under 18 included in this application DA/YES NE/NO DA/YES DA/YES DA/YES DA/YES DA/YES NE/NO NE/NO NE/NO NE/NO NE/NO NE/NO

18 Da li je netko od srodnika podnositelja zahtjeva zaposlen u dravnim tijelima Republike Hrvatske ili u inozemstvu (ako jest navesti naziv tijela i funkciju) If any member of the applicants family is employed by any of the Croatian Government bodies or Government bodies of other country (countries), please state the name of the Government body and his/hers position / occupation.

DA/YES

PRILOZI UZ ZAHTJEV ZA STJECANJE HRVATSKOG DRAVLJANSTVA DOCUMENTS ATTACHED WITH THE APPLICATION FOR CROATIAN CITIZENSHIP
Molimo da navedete sve priloene dokumente upisivanjem znaka (x) u slobodnom polju s desne strane tabele ili upisivanjem naziva/vrste dokumenta Please indicate all the documents enclosed with the application with a sign (x) in the appropriate empty space on the right side of the table or/and by writing the name(s)/type(s) of the enclosed document(s):
DOKUMENTI KOJE OBVEZNO TREBA PRILOITI UZ SVAKI ZAHTJEV (UKLJUUJUI I ZAHTJEVE KOJI SE PODNOSE U IME MALOLJETNE DJECE) DOCUMENTS TO BE SUBMITTED WITH EVERY APPLICATION (INCLUDING THE APPLICATIONS ON BEHALF OF THE CHILDREN UNDER 18)

1 Kratki ivotopis datiran, potpisan i sadri:

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Short Curriculum/Biography/ Resume (in the Croatian language) dated, signed and including: - osobne podatke, - personal introduction and short family history - kratku povijest obitelji - reasons for applying for Croatian citizenship - razloge za traenje dravljanstva RH Proof of the current citizenship and identity, Dokaz o dravljanskom statusu / isprava o which is A VALID PASSPORT identitetu VAEA PUTNA ISPRAVA hrvatski Izvadak iz matine knjige roenih (izvornik dokumenta) Original of the Croatian document RODNI LIST, koji moe biti: novozelandski Izvadak iz matine knjige roenih preveden na hrvatski jezik i ovjeren Apostille peatom (izvornik dokumenta) BIRTH Original New Zealand Birth Certificate, translated into the Croatian language CERTIFICATE and authenticated with the Apostille stamp that can be Rodni list neke druge zemlje izdan na meunarodnom obrascu ili preveden in the form of i ovjeren sukladno meunarodnim ugovorima i konvencijama the: Other country Birth Certificate issued on the international form or translated and authenticated according to the requirements of the international law ZA UDANE hrvatski Izvadak iz matine knjige vjenanih (izvornik dokumenta) Original of the Croatian document ENE VJENANI novozelandski Izvadak iz matine knjige vjenanih preveden na hrvatski LIST, jezik i ovjeren Apostille peatom (izvornik dokumenta) koji moe biti: FOR MARRIED Original New Zealand Marriage Certificate, translated into the Croatian language and authenticated with the Apostille stamp WOMEN Vjenani list neke druge zemlje izdan na meunarodnom obrascu ili MARRIAGE CERTIFICATE, preveden i ovjeren sukladno meunarodnim ugovorima i konvencijama that can be in the Other country Marriage Certificate issued on the international form or translated and authenticated according to the requirements of the international law form of the: FOR CROATIAN EMIGRANT OR HIS/HERS DESCENDANT, PLEASE ENLIST ALL THE DOCUMENTS ENCLOSED AS A PROOF OF CROATIAN DESCENDENCY

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ZA ISELJENIKE I POTOMKE ISELJENIKA NAVEDITE SVE DOKUMENTE KOJE PRILAETE KAO DOKAZ HRVATSKOG PORIJEKLA OEV/A FATHERS MAJIN/A MOTHERS DJEDOV/A GRANDFATHERS BAKIN/A GRANDMOTHERS
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KADA ZAHTJEV PODNOSI BRANI DRUG ISELJENIKA KOJI JE STEKAO HRVATSKO DRAVLJANSTVO

FOR APPLICANTS THAT ARE MARRIED TO AN EMIGRANT WHO ACQUIRED THE CROATIAN CITIZENSHIP

Izvod iz matine knjige vjenanih (vidi pod A 4) / Marriage certificate (see as per A 4) Rjeenje o primitku u hrvatsko dravljanstvo branog druga Document confirming that the spouse has been granted Croatian citizenship (Rjeenje) Domovnica i/ili hrvatska putovnica branog druga Spouses Croatian passport and/or Certificate of Croatian Citizenship (Domovnica)
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WHEN APPLYING ON BEHALF OF YOUR KADA SE ZAHTJEV PODNOSI U IME CHILDREN UNDER 18 yoa MALOLJETNE DJECE Izvod iz matine knjige vjenanih (vidi pod A 4) / Marriage certificate (see as per A 4) ZA SVAKO DIJETE:- Izvod iz matine knjige roenih (vidi pod A 3) navesti broj djece FOR EACH CHILD: Birth certificate (see as per A 3) please indicate the number of children ZA SVAKO DIJETE: Dokaz o dravljanstvu / identitetu-vaea putna isprava (vidi pod A 2) FOR EACH CHILD: Proof of the current citizenship / identity a valid passport (see as per A 2) ZA SVAKO DIJETE KOJE JE NAVRILO 14 GODINA: Izjava da je suglasno sa zahtjevom (osobno potpisana u Konzulatu) FOR EACH CHILD 14 yoa. OR OLDER: A statement of consent (to be signed in the Consulate)
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KADA SE ZAHTJEV PODNOSI TEMELJEM PRIPADNOSTI HRVATSKOM NARODU Vlastoruno potpisana izjava o pripadnosti hrvatskom narodu Dokaz(i) o osobnom nacionalnom izraavanju u pravnom prometu kao to su: radna knjiica vojna knjiica, svjedodba, indeks i dr. ukoliko je u ovim dokumentima upisan podatak o nacionalnosti (izvornik ili ovjereni preslik). Navesti priloene dokumente:

UKOLIKO STRANKU ZASTUPA PUNOMONIK Specijalna punomo kojom se punomonik izriito ovlauje za zastupanje u predmetu stjecanja hrvatskog dravljanstva Power of Attorney, authorizing the legal representative to act on behalf of the client in the matter of acquiring the Croatian Citizenship POTVRDA O NEKANJAVANJU POLICE CLEARANCE

WHEN APPLYING THROUGH THE LEGAL REPRESENTATIVE Potpisana u Konzulatu na hrvatskom jeziku ili Written/translated into the Croatian language and signed in Croatian Consulate or Napisana na engleskom jeziku i ovjerena kod NZ javnog biljenika, te naknadno prevedena i ovjerena Apostille peatom Written in English, signed in front and witnessed by the Notary Public, than translated into the Croatian language and further authenticated with the Apostille stamp Originalni novozelandski dokument, preveden i ovjeren Apostille peatom Original New Zealand document, translated into the Croatian language and authenticated with the Apostille stamp.

Zahtjev zaprimljen u Aucklandu dana: Application received on the day: Potpis podnositelja zahtjeva: Applicantsignature: Potpis slubene osobe: Signature of the Consular official: