aa test Given name/s: Family name: Current postal address: Email: * Mobile: Born date: Location born: Gender Female Male × Recorded as a Citizen and/or Resident of Deos Terrum (3 Denarii ~ $15AUD) * Citizen or Resident of Deos Terrum $15.00 Proration Discount 0 Total 0 Select Payment Gateway Credit Card Username (for website login) * Username Password: * Confirm Password: * Application You are applying for (choose one only): * Citizenship (with Diplomatic Passport) Citizenship status only (no Passport, can request later) Residential status only Citizenship and Residential status (no Passport, can request Passport later) Citizenship and Residential status (with Diplomatic Passport) Visa application only Nationality Nationality Declaration (explanations below) Sole National of Deos Terrum - Deos Terran Dual National - Deos Terran + another nationality Commonwealth National - Deos Terrum AffiliationSole NationaI - I declare that I renounce all other claimed nationalities and stand solely as a national and citizen of Deos Terrum (Deos Terran). Dual National (recommended) - I declare that I am a citizen or national of another nation and also a citizen of Deos Terrum (eg Deos Terran — Commonwealth). Commonwealth National - I declare that I am a Commonwealth national by heritage and a citizen of Deos Terrum (Custos Terra Dei), and that my standing is with the original and non-corporate Commonwealth, not with the corporate Australian Government. Passport photo (only for Passport application) I will email a suitable passport photo to office@deosterrum.com I am not requesting a Passport (no photo required) You will be declaring citizen and/or residential status from what date? Visa applications Details of intended stay: 0 charactersProvide: 1) intended length of stay 2) intended date of arrival 3) If more than one day, what accommodation arrangements have been secured? Would you like an invitation to weekly Wednesday Zooms for Citizens and Residents only (4pm Western Australia time)? Yes No Additional Records AutomotiveAutomobile (details at right) If recording more than one automobile, separate entries by "/" or "1)", "2)", or another means so that first description is automobile 1, second is automobile 2 etc Manufacturer Year of manufacture Model Colour VIN number Identification plate Additional Records AnimalDog Cat If recording more than one animal, separate entries by "/" or "1)", "2)", or another means so that first description is animal 1, second is animal 2 etc Breed Age (MM/YYYY born) Colour Name Microchip number (if known) Record details as chosen above
