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Applicationform
for
the "Free Republic of Fadeland" citizenship
(Information of this sheet might be exhibited/ published. You can avoid this by ticking the data that you would like to be treated as confidential.)
Surname/ Apellidos / Nom:
Given names/ Nombre/ Prenoms:
Nationality/ Nacionalidad/Nationalite:
Date of birth/ Fecha de nacimiento/ Date de naissance:
Place of birth/ Lugar de nacimiento/ Lieu de naissance:
Residence/ Domicilio/ Domicile:
Religious name or pseudonym/ Nombre de pila o seudonimo:
Colour of eyes/ Color de los ojos/ Couleur des yeux:
Height/ Altura/ Taille:
Children/ Hijos/ Enfants: Surname and given names/
Apellidos y nombre/ Nom et prenoms:
Date of birth/ Fecha de nacimiento/
Date de naissance:
Sex/ Sexo/ Sexe:
Occupation/ occupatin/ occupation:
Contact: (e-mail, homeaddresse, Tel.)
Signature/ Signatura: _______________________ Place,date/ Lugar,Fecha:_______________________
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Please send your applicationform together with a passportphoto to the Fadeland Ambassador at
andreas_uhl@talk21.com
You will then receive an email that will tell you about how to pay the GBP 5 for the passport.
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