Nationality Declaration Affidavit Form

Nationality Declaration Affidavit Form
Please complete this form to declare your nationality status. Ensure all information provided is accurate and truthful.
Full Name
First NameLast Name
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Place of Birth (City, Country)
Current Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Current Nationality
Have you ever held any other nationality?
If yes, please specify previous nationality (if applicable)
Upload supporting document (e.g., birth certificate, previous nationality document)
Cancelof
Signature of Declarant
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Date of Declaration
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: