Application Form for World Passport, World Birth Card, World Birth Certificate, & World Identity Card
|
World Service Authority, World Office 5 Thomas Circle N.W., Washington, D.C. 20005, USA Tel: (202) 638-2662 Fax: (202) 638-0638 |
INSTRUCTIONS
- This application is free. Please use as many additional forms as needed;
- Print application form. Applications must be made in writing;
- Mark which documents and postage you want (minimum shipping/handling required per applicant);
- Fill out personal information in block letters by hand, by computer, or by typewriter;
- Sign ATTESTATION OF UNDERSTANDING AND CERTIFICATION OF INFORMATION;
- Have your signature authenticated;
- Send with 2 photos and certified bank check in US dollars with US bank name on front of check, international money order in US dollars, international postal money order, Western Union QuickPay to code city WSA, DC with account number 4624, completed credit card form below, PayPal (email/call for instructions) or MoneyGram (email/call for instructions) to the above address; For other fee payment options, please contact the WSA.
- For expedited issuance services, please contact the WSA Washington, DC World Office;
- No WSA document will be issued without payment or proof thereof.
Document Orders
| ---World Passport--- | ___ World Identity Card / US$25 |
| ___ 10 years / US$100 | ___ World Birth Card / US$25 |
| ___ 5 years / US$75 | ___ World Birth Certificate / US$25 |
| ___ 3 years / US$55 | |
| ___ World Donor Passport (15 years) |
Required US and international shipping and handling fees (per applicant):
Within USA ___ US $5 (required minimum) ___ US $10 (with Certified Return Receipt)
International Mail ___ US $10 (required minimum) ___ US $25 (International Registered Mail)
Personal Information
(For Office Use Only) WSA#______________________ Last Name __________________________ First & Middle Names ___________________________ 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) (O) Height____________________ Color of Eyes______________________ Special Marks ________________________ Occupation ___________________________________ (For World Birth Card and Certificate, answer the following:) Father's Name_________________________ Mother's Name_________________________________
Submit 2 photos and print your name on the back of one. Color accepted. Photos should be between 1 and 2 inches. Photos are for file, replacement if necessary, and ID card, in addition to passport.
Address to which documents should be sent:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Attestation
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:
________________________________________
Applicant's Fingerprint:
_____________________ | | | | | | | | | | | | | | ---------------------If you require forms or information in other languages, please specify below.
| Send me _____ applications in |
CREDIT CARD PAYMENT FORM
You may make donations and pay service fees by credit card. Please complete the form below and return it to the WSA with
the completed application form above. You must include a photocopy of the front side and back side of your credit card. Please note that there are NO REFUNDS or EXCHANGES.Type of Credit Card (Check One):
Credit Card Number:________________________________ Expiration Date (Month/Year): _________
Name as it appears on the card: ________________________________ 3-digit CV code: ________
(on back side of card) Authorized Signature and Date: _________________________________
Telephone & email of card holder: _______________________________
Billing Address
including Postal (Zip) Code: ____________________________________
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