Principauté du Zakistan - Principality of Zakistan

Ministère d'État - Bureau des affaires administratives

Official Application Form for E-RESIDENCY — Formulaire n° : ER-ZK/01

All personal data provided in this form are encrypted and handled in accordance with the Zakistanian Data Protection Framework under the authority of the Ministry of State.

Instructions

Please complete this form accurately and legibly in English or French. Incomplete or inaccurate information may delay or invalidate your application.All applications are subject to review by the Ministry of State and require the Sovereign’s approval.

1. APPLICANT INFORMATION

First name

Last name

Birthday

Month

Day

Year

Place of Birth

Nationality

Gender

Male

Female

2. CONTACT INFORMATION

Phone (including country code)

Country of Residence:

City of Residence

3. DIGITAL IDENTITY DETAILS

Preferred Username / Digital ID (optional):

Profession / Main Activity:

Photographie pour la carte d’e-résident

Une photographie officielle pourra être demandée ultérieurement par la Chancellerie Princière pour la production de la carte d’e-résident.

Je confirme être en mesure de fournir une photographie d’identité conforme lors de la phase finale de validation.

6. DECLARATION

I hereby declare that the information provided in this application is accurate and truthful to the best of my knowledge.

I understand that the Zakistan E-Residency program provides a digital identity issued by the Principality of Zakistan and does not constitute citizenship or legal residency in any jurisdiction.