I, the undersigned, do hereby, willingly and consciously, declare myself to be a Citizen of the World. As a World Citizen, I affirm my planetary civic commitment to WORLD GOVERNMENT, founded on three universal principles of One Absolute Value, One World, and One Humanity which constitute the basis of World Law. As a World Citizen I acknowledge the WORLD GOVERNMENT as having the right and duty to represent me in all that concerns the General Good of humankind and the Good of All. As a Citizen of World Government, I affirm my awareness of my inherent responsibilities and rights as a legitimate member of the total world community of all men, women, and children, and will endeavor to fulfill and practice these whenever and wherever the opportunity presents itself. As a Citizen of World Government, I recognize and reaffirm citizenship loyalties and responsibilities within the communal state, and/or national groupings consistent with the principles of unity above which constitute now my planetary civic commitment.
Signature of World Citizen and Date
Fill out below and sign Affirmation above and return with fee to:
World Service Authority * Suite 205 * 1012 14th Street, NW * Washington, D.C. 20005 * Tel: (202) 638-2662 * Fax: (202) 638-0638
Please type or print all information
Please include your US$30 world citizenship registration fee and choose the left or right column below according to your preference of making an annual financial commitment:
GENDER: M F
BIRTHDATE: DAY_____ MONTH_____ YEAR___
CURRENT MAILING ADDRESS:
Registration fee: US$30
Registration fee: US$30
|---World Passport---||___ World Identity Card / US$20|
|___ 8 years / US$100||___ World Birth Card / US$20|
|___ 5 years / US$75||___ World Birth Certificate / US$20|
|___ 3 years / US$45|
|___ World Donor Passport (15 years)|
(The World Donor Passport is issued for a donation of at least US$400 to the World Refugee Fund, which enables the WSA to issue free WSA documents to needy refugees and stateless persons. The World Donor Passport is similar to a regular WSA World Passport except that it has a special, gold-embossed cover and is valid for a 15-year period.)
Required US and international shipping and handling fees (per applicant):
Within USA ___ US $5 (required minimum) ___ US $8 (with Certified Return Receipt)
International Mail ___ US $10 (required minimum) ___ US $20 (International Registered Mail)
(For Office Use Only) WSA#______________________
Last Name __________________________ First Name(s) ___________________________
Street______________________________ City & Postal Code ______________________
State Province______________________ Country _________________________________
Telephone___________________________ Fax _____________________________________
Email and Personal Internet Web Site _________________________________________
Place of Birth________________________________________________________________
Date of Birth DAY:___________ MONTH:_________________________ YEAR:___________
Gender (M) (F) Height___________________ Color of Eyes____________________
Special Marks ______________________ Occupation ______________________________
(For World Birth Card and Certificate, answer the following:)
Father's Name_____________________ Mother's Name______________________________
Submit 4 photos and print your name on the back of each one. Color accepted. Photos should be between 1 and 1 3/4 inches. Photos are for file, replacement if necessary, and ID card, in addition to passport.
Address to which documents should be sent:
ATTESTATION OF UNDERSTANDING AND CERTIFICATION OF INFORMATION: The applicant understands that the World Service Authority accepts no responsibility for the position of any government as regards the acceptance of the WSA passport and/or its other identification documents. The applicant is solely responsible for the use of the passport and accompanying documents, which are the bearer's property. The applicant swears that the information on this form is true and correct. Important: Applicants under 16 years of age must have the Attestation of Understanding signed by a parent or guardian.
Signature and Date
CERTIFICATION OF SIGNATURE, OR PHOTOCOPY OF IDENTITY PAPERS, OR PRINT OF RIGHT INDEX FINGER
On this ______ day of ______________, 20____, before me came_________________________________________, known to me and known by me to be the person who executed the foregoing application, and he/she thereupon duly acknowledged to me that he/she executed the same.
Certifying Official Signature and Seal:
International Exit Visa (IEV) / International Residence Permit (IRP)
Please include the :
International Exit Visa (IEV) (US$15) in my passport ____.
World Citizen information below necessary only for those applying for the IRP. If applicant is not yet a registered World Citizen, application for such must be submitted with request for IRP. See world citizen registration application at www
World Citizen information below necessary only for those applying for the IRP. If applicant is not yet a registered World Citizen, application for such must be submitted with request for IRP. See world citizen registration application at www worldserviceorg/reg html
(Please include current city & country of residence) ____________________________________________________________ ____________________________________________________________ (The above address will appear on the IRP) (Post office boxes will be disregarded.)
As the individual directly concerned, and with full knowledge of the human rights from which they derive, I understand that I am wholly responsible for the function, applicability and employment of both the IEV and the IRP with regard to all national officials and ministries.
Applicants who already hold a WSA passport must send in their passport to a WSA office with completed application, issuing fee(s) and registered postage cost of US$20.
FOR WSA OFFICIAL USE ONLY :
IEV ________ Date of Issue _______ Place of Issue ______ No. of
IRP ________ Date of Issue _______ Place of Issue ______ WSA PP
No. ________ Date of Issue _______ Place of Issue ______ __________
Date Received ______________
a registered citizen of the WORLD GOVERNMENT OF WORLD CITIZENS.
No.___________, facing persecution from_______________________ claim the right of WORLD POLITICAL ASYLUM under Article 14(1), UNIVERSAL DECLARATION OF HUMAN RIGHTS . In accordance with this sovereign claim, I herewith request the WORLD GOVERNMENT OF WORLD CITIZENS to issue to me, through its administrative agency, the World Service Authority, the official WORLD POLITICAL ASYLUM CARD.
Subject to my written approval, I understand that a confirma- tion of this status will be made available to the competent au- thorities of the states involved, as well as to the United Nations Secretary-General and the Chief Justice, World Court of Human Rights .
I herewith affirm that this request is made not because of prosecutions arising from non-political crimes or from acts con- trary to the purposes and principles of the United Nations.
Height __________ Color of Eyes __________
Application and issuing fee: $10 (or equivalent in negotiable currency). Postage not included. Please refer to required shipping and handling fees on the passport application form. Bank checks in US dollars drawn off a bank in the US, international money orders or IRCs accepted. Send with two passport-size photos to: WSA, Washington, D.C. 20005.
Applicants must register as a world citizen at the same time they apply for the World Political Asylum Card. See world citizen registration form at www worldservice org /reg html
On this________day of______________________________________.
20__, before me came_______________________________________.
Known to me and known by me to be the person who executed the foregoing application, and he/she thereupon duly acknowledged to me that he/she executed the same.Certifying Official
(Please print or type)Name:________________________________________________