NOMINEE CITIZEN-THE KINGDOM OF NEW ATLANTIS (WISDOMLAND)

(FREE)

1. Given Name
2. Family Name
3. Fathers Name 4. Mothers Name
5. Have you been known by any 6. Date of Birth
other names?
7. Sex 8. Place of Birth
9. Color of eyes 10. Age
11. Color of Hair 12. Height
13. Distinguishing Marks 14. Nationality
15. Do you hold any other 16. marital status
Nationality?
17. National identify card No. 18. Country

19. Passport No. 20. E-mail

21. Home Address

22. Telephone 23. Work/ profession

24. Languages

25. Do you have a serious 26. Have you been convicted of

contagious, transmissible or a crime or misdemeanor, or
hereditary disease, condition or a have been sentenced to spend
physical disability or mental time in prison or any other
retardation? form of detention?
27. Ambassador

I declare that the information filled in this form, and any attachments, is
Date / / complete, correct and up to date in every detail.

I understand that if I have given false or misleading information, my

Consent signature
application may be refused.

I declare By signing below my nomination for citizenship, I agree to be subject

to the provisions of the Laws of The Kingdom of New Atlantis
(WISDOMLAND) and to abide by the

The government of the Kingdom of new

Atlantis (WISDOMLAND) is committed to
grant a free citizenship certificate to applicants
after processing their applications in Dr. Mohammad Alabaddi
accordance with the law. Prime Minister