Application Form for World Passport, World Birth Card, World Birth Certificate, & World Identity Card

INSTRUCTIONS

1. This application is free. Please use as many additional forms as needed. Completed forms may be posted or emailed to the WSA.
2. Mark which documents and postage/shipping you want (minimum shipping/handling required per applicant);
3. Fill out personal information in block letters by hand, by computer, or by typewriter;
4. Sign ATTESTATION OF UNDERSTANDING AND CERTIFICATION OF INFORMATION and DATA CONSENT;
5. Verify your identity OR have your signature authenticated by notary;
6. Send with 2 photos;
7. Provide fees by certified bank check in US dollars with US bank name on front of check, international money order in US dollars, completed credit card form below, or PayPal (email/call for info) to the above address. For other payment options, please contact WSA;
8. For expedited issuance, additional fees are required PER applicant. Approximate business days for issuance: 30 __($50), 15 to 20 __($75), 5 to 10 __($150). (Does not include shipping time & shipping fee is extra.) Due to unforeseen circumstances, expedited service may take longer than listed. Normal issuance is 4 months or longer;
9. No WSA document will be issued without payment or proof thereof.

Document Orders

Choose One Passport Cover:

          ___World Passport Cover       ___World Government Cover  (More Info HERE)

---World Passport---	---Other Documents---
___ 10 years / US$125	___ World Identity Card / US$35
___ 5 years / US$100	___ World Birth Card / US$35
___ 3 years / US$75	___ World Birth Certificate / US$35
___ World Donor Passport (15 years)

(The World Donor Passport is issued for a donation of at least US$500 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):(See other shipping options HERE)

Within USA ___ US $5 (required minimum) ___ US $15 (with __Certified Return Receipt or __Priority Mail)

International Mail ___ US $10 (required minimum) ___ US $40 (International Registered Mail)

 

Personal Information

Choose Format: ___ALL CAPITALS or ___Upper & Lower Case          WSA#______________________ (For Office Use Only)


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: By signing below, 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. Fees are non-refundable. The applicant swears that the information on this form is true and correct. Important: Applicants under 18 years of age must have the Attestation of Understanding and Data Consent signed by a parent or guardian.

DATA CONSENT: By signing below, the applicant gives explicit consent (opts in) to provide and share their personal information and data.

Signature and Date

 

___________________________________________________

 

VERIFICATION OF IDENTITY: by 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:

 _____________________
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If you require forms or information in other languages, please specify below.

Send me _____ applications in

French Spanish German Russian Arabic Japanese

 

CREDIT CARD PAYMENT FORM

You may make donations and pay service fees by credit card. Please complete the online payment form by CLICKING ON THE DONATE BUTTON below. Please note that there are NO REFUNDS or EXCHANGES.

If you prefer to make donations and pay service fees offline, you may by submit your credit card information by post or by fax to 202-638-0638. Or you may call us by phone to charge your card. Do NOT send the following form by email. Please note that there are NO REFUNDS or EXCHANGES.

Type of Credit Card (Check One):

Visa

Mastercard

Discover

Diner's Club

American Express

Credit Card Number:________________________________      Expiration Date (Month/Year): _________

Name as it appears on the card: ________________________________     3-digit CV code: ________                                                                                                            (on back side of card)

                                                                              or ________ 4-digit CV code (on front of card)

Authorized Signature and Date: _________________________________

Telephone & email of card holder: _______________________________

Billing Address
including Postal (Zip) Code: ____________________________________