world id

World Service Authority, World Office5 Thomas Circle N.W.,

Washington, D.C. 20005, USATel: (202) 638-2662Fax: (202) 638-0638

INSTRUCTIONS

This application is free. Please use as many additional forms as needed;1.Print application form. Applications must be made in writing;2.Mark which documents and postage 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;5.Have your signature authenticated;6.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 tocode city WSA, DC with account number 4624, completed credit card form below, PayPal (email/callfor instructions) or MoneyGram (email/call for instructions) to the above address; For other feepayment options, please contact the WSA.

7.

For expedited issuance services, please contact the WSA Washington, DC World Office;8.No WSA document will be issued without payment or proof thereof.9.

DOCUMENT ORDERS

---World Passport--- ___ World Identity Card / US$25___ 8 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)

(The World Donor Passport is issued for a donation of at least US$400 to the World Refugee Fund, whichenables the WSA to issue free WSA documents to needy refugees and stateless persons. The World DonorPassport is similar to a regular WSA World Passport except that it has a special, gold-embossed cover and isvalid for a 15-year period.)

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

APPLICATION FORM FOR WORLDPASSPORT, WORLD BIRTH CARD,

WORLD BIRTH CERTIFICATE, & WORLDIDENTITY CARD

Application Form http://www.worldservice.org/appform.html

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(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 2 photos and print your name on the back of one. Color accepted. Photos should be between 1 and 2inches. 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 thatthe World Service Authority accepts no responsibility for the position of any government as regards theacceptance of the WSA passport and/or its other identification documents. The applicant is solely responsiblefor the use of the passport and accompanying documents, which are the bearer's property. The applicantswears that the information on this form is true and correct. Important: Applicants under 16 years of age musthave the Attestation of Understanding signed by a parent or guardian.

Signature and Date

___________________________________________________

CERTIFICATION OF SIGNATURE, OR PHOTOCOPY OF IDENTITY PAPERS, ORPRINT OF RIGHT INDEX FINGER

On this ______ day of ______________, 20____, before mecame_________________________________________, known to me and known by me to be the person


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who executed the foregoing application, and he/she thereupon duly acknowledged to me that he/she executedthe 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

French Spanish German Russian Arabic Japanese

CREDIT CARD PAYMENT FORM

You may make donations and pay service fees by credit card. Please complete the form below and return it tothe WSA with the completed application form above. You must include a photocopy of the front side andback side of your credit card. 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)

Authorized Signature and Date: _________________________________

Telephone & email of card holder: _______________________________

Billing Addressincluding Postal (Zip) Code: ____________________________________

© Copyright (c) 2014 World Service Authority. All rights reserved.

The World Service Authority, and the human-embracing-the-globe logo are service marks or registered service marks of the

World Service Authority throughout the world.


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world id

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