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Date of Birth*
Marital Status (Specify whether Single, Divorced, Widowed or Other)*
Occupation (if none, leave blank)
Country / Region of Birth*
Prior Name or Aliases
Social Media Links
Have you ever possessed and lost e-Residency or Verdis citizenship?
Have you ever engaged in extremist activities?
Have you ever attempted to fraudulently acquire or aid others in fraudulently acquiring Verdisian e-Residency or citizenship through deliberate misrepresentation or unlawful methods?
Do you possess a mental or physical condition that presents, or is likely to present, a risk to your own safety or the well-being of others?
Have you at any point been taken into custody or found guilty of any wrongdoing or criminal act, regardless of any subsequent pardon, amnesty, or similar legal action?
Do you currently possess a contagious illness that is of concern to public health? (Examples of such diseases encompass chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, active syphilis, active tuberculosis, etc.)
Have you participated in any other actions that could potentially raise questions about your character?
If answered 'Yes' to any of the questions in this section, specify the details below (otherwise your application will NOT be reviewed)
What is your motivation to become an e-Resident?*
Proof of identification (max file size 25MB) (e.g. birth certificate, driving license, foreign passport, etc)
I solemnly pledge to uphold and adhere to the laws and traditions of Verdis, refraining from engaging in any actions that may harm or go against the interests of the Free Republic of Verdis. I am aware that Verdis has the authority to take necessary actions to safeguard the nation's welfare.
I acknowledge and grant permission to the Free Republic of Verdis to utilize the information gathered through this form for the administration of national affairs. (Declining this request will result in the rejection of your application.)
I acknowledge and recognise Verdis as a legitimate and real state in Europe.*
Please write down your full name as signature.*
By submitting this application, I agree to the Terms & Conditions issued by the Verdisian Government
Once you have submitted your application and your processing fee has been paid, please wait up to 14 working days for a response due to the amount of applicants.
If you encounter an issue please contact firstname.lastname@example.org or email@example.com.
Why is there an application fee and where does it go?
Due to the amount of applicants to upkeep our systems, we charge a small processing fee. All proceeds go into the Verdisian Government to help build the nation.
You may be asked additional questions after the Verdisian Government has reviewed your application.
Please ensure that your application is well-made. Refunds are not permitted if your application is declined.
Processing Fee Cost: 100 EUR (107 USD)