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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 Verdisian Citizenship?
Have you ever engaged in extremist activities?
Have you ever sought to obtain or assist others to obtain Verdisian Citizenship by fraud or willful misrepresentation or other unlawful means?
Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others?
Are you or have you ever been a drug abuser or addict?
Have you ever been arrested or convicted for any offence or crime, even though subject of a pardon, amnesty, or other similar action?
Do you have a communicable disease of public health significance? (Communicable diseases of public significance include chancroid, gonorrhoea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, etc.)
Have you engaged in other activities that might indicate you may not be considered a person of good 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 a citizen of Verdis?*
What can you contribute to Verdis?*
Proof of identification (max file size 25MB) (e.g. birth certificate, driving license, foreign passport, etc)
I pledge to respect and obey the laws and customs of Verdis and to not commit any action against Verdis. I understand that in case of high treason discovered, the Free Republic of Verdis may and will take measures to protect the interests of the nation.
I hereby understand and authorize the Free Republic of Verdis to use my data collected through this form for purposes related to the management of the nation. (If stated no, your application will be declined.)
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: 16 USD