World Political Asylum Card Application
WORLD SERVICE AUTHORITY
5 Thomas Circle, NW
Washington, D.C. 20005
Tel: (202) 638-2662
Founded in 1954 to implement human rights
APPLICATION FORM FOR WORLD POLITICAL ASYLUM
a registered citizen of the WORLD GOVERNMENT OF WORLD CITIZENS.
No.___________, facing persecution from_______________________ claim the right of WORLD POLITICAL ASYLUM under Article 14(1), UNIVERSAL DECLARATION OF HUMAN RIGHTS . In accordance with this sovereign claim, I herewith request the WORLD GOVERNMENT OF WORLD CITIZENS to issue to me, through its administrative agency, the World Service Authority, the official WORLD POLITICAL ASYLUM CARD.
Subject to my written approval, I understand that a confirma- tion of this status will be made available to the competent au- thorities of the states involved, as well as to the United Nations Secretary-General and the Chief Justice, World Court of Human Rights .
I herewith affirm that this request is made not because of prosecutions arising from non-political crimes or from acts con- trary to the purposes and principles of the United Nations.
Height __________ Color of Eyes __________
Application and issuing fee: $10 (or equivalent in negotiable currency). Postage not included. Please refer to required shipping and handling fees on the passport application form. Bank checks in US dollars drawn off a bank in the US, international money orders or IRCs accepted. Send with two passport-size photos to: WSA, Washington, D.C. 20005.
Applicants must register as a world citizen at the same time they apply for the World Political Asylum Card. See world citizen registration form at www.worldservice.org/reg.html
CERTIFICATION OF SIGNATURE, OR PHOTOCOPY OF IDENTITY PAPERS OR PRINT OF RIGHT INDEX FINGER.
On this________day of______________________________________.
20__, before me came_______________________________________.
Known to me and known by me to be the person who executed the foregoing application, and he/she thereupon duly acknowledged to me that he/she executed the same.
Seal and Signature