Details of spouse

Tick if applicable

Details of father

Tick if applicable

Details of mother

Tick if applicable

Details of children

Tick if applicable

Details of siblings

Tick if applicable

Spouse's Information

First Name

Current first name, as per passport

Middle Name

Current Middle name, as per passport

Surname

Current Surname, as per passport

City

City of Birth

Country

Country of Birth

Date of Birth

Address Line 1

Address Line 2

City

State

Zip / Postal Code

Country

Father's Information

First Name

Current first name, as per passport

Middle Name

Current middle name, as per passport

Surname

Current Surname, as per passport

City

City of Birth

Country

Country of Birth

Birth Date

Address Line 1

Address Line 2

City

State/Province

Country

Mother's Information

First Name

Current first name, as per passport

Middle Name

Current middle name, as per passport

Surname

Current surname, as per passport

City

City of Birth

Country

Country of Birth

Birth Date

Address Line 1

Address Line 2

City

State/Province

Zip / Postal Code

Country

Children's Information

First Name

Current first name, as per passport

Middle Name

Current middle name, as per passport

Surname

Current Surname, as per passport

City

City of Birth

Country

Country of Birth

Date of Birth

Address Line 1

Address Line 2

City

State/Province

Zip / Postal Code

Country

Sibling's Information

First Name

Current first name, as per passport

Middle Name

Current middle name, as per passport

Surname

Current Surname, as per passport

City

City of Birth

Country

Country of Birth

Birth Date

Address Line 1

Address Line 2

State/Province

City

Zip / Postal Code

Country

Details of education

Tick if applicable

Educational Details

Name of institution

Qualification obtained

City

Country

From

Details of employment

Tick if applicable

Employment Details

Position

Full name of employer

Type of business

City

Country

From

PASSPORT INFORMATION

Refer to your passport and enter all information in the same format.

OTHER CITIZENSHIP/NATIONALITY

Are you now, a citizen or national of any other country?

Have you ever been a citizen or national of any other country?

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Privacy and Information Release & Declaration

I hereby authorize, without reservation, the Kingdom of Kush and/or any agents or representatives that the Kingdom may appoint, to:Verify any information about me, my spouse, my children, or my parents, as required;Obtain additional information, including credit reports, police reports, Interpol records, or any other report which the Kingdom may determine to be relevant to this application, and I understand that such information, reports, and records may be obtained from public sources, government agencies or private agencies. I authorize any agency contacted by the Kingdom of Kush and/or its appointed agents or representatives to furnish the requested information, reports or records about me or my family members, and I release all parties involved from any responsibility and liability for doing so; andRelease any information in the forms of this application or otherwise, and any other information obtained by the Kingdom of Kush in order to verify that such information is complete, truthful, and accurate, and to obtain such other information as the Kingdom of Kush may determine is useful in determining whether to grant Permanent Residence status of Citizenship status to me and my dependents included in this application or for such other purposes as are set out in the laws of Kingdom of Kush.If there is any change in my circumstances during the interim period between the date of this application and the date of the granting of citizenship which affects the information I have given in this application, I confirm that I will promptly advise the Citizenship by Investment Unit in writing.

I hereby apply, with full understanding and without reservation or legal impediment, to become a citizen of Kingdom Of Kush by virtue of the Kingdom Of Kush Citizenship by Investment Act, 2013. In the event that the honor of citizenship in Kingdom Of Kush is granted to me, I solemnly pledge that: I will faithfully and carefully observe the laws of Kingdom Of Kush at all times; I will not conduct myself in a manner which will bring dishonor or disrepute to Kingdom Of Kush or its people; and I will not act against the interests of Kingdom of Kush. I hereby confirm that I will abide in all respects with the provisions of the Kingdom Of Kush Citizenship by Investment Act, 2013.