CHARACTER
24. Please answer the following questions about yourself.
Convicted of a crime or offense No __ Yes __  To be approved
Sentenced to serve a period of time in jail or in other form of detention No __ Yes __ you are required
Placed on probation No __ Yes __ to be of good
Charged pending trial No __ Yes __ character.
If Yes to any question above, give details below.  (If necessary, use additional sheets of paper.)
 Full Name  ___________________________________________________________________________
 Nature of Offense  ______________________________________________________________________
Nature of Court __________________________ Country ______________________________ Date of sentencing
DAY / MONTH / YEAR
Sentence __________________________________________________________    ____ / ____ / ______
 Full Name  ___________________________________________________________________________
 Nature of Offense  ______________________________________________________________________
Nature of Court __________________________ Country ______________________________ Date of sentencing
DAY / MONTH / YEAR
Sentence __________________________________________________________    ____ / ____ / ______
25. Have you ever served in the armed forces? No __ Yes __
Nationality ______________________________________________  Date of Discharge Rank
Service ______________________________________________  DAY / MONTH / YEAR
____ / ____ / ______
__________
Type of Discharge ___________________________________________________________________
Training or Specialty ___________________________________________________________________
26. Have you ever been:
Deported, excluded or removed from any country? No __ Yes __
Asked to leave a country? No __ Yes __
Refused entry to any country? No __ Yes __
Refused a visa (including a visa to migrate to any country)? No __ Yes __

DECLARATION
I declare that the information supplied on this form, and any attachments, is complete, correct and up­to­date in every detail.
I understand that if I have given false or misleading information, my application may be refused.
I undertake to inform the New Utopian Government Office of any material changes to my circumstances while my application is being considered.
I declare that I have read and understood the information supplied to me and in particular the information contained in the Explanatory Notes to this application.
By signing below or otherwise permitting my nomination for citizenship, I agree to be subject to the provisions of the Constitution of the Principality of New Utopia and to abide by the laws duly passed in accordance with it.
  Signature of Nominee     N.B: If Nominee is under the age of 18, his Nominee Form must be signed by his parents.
Date
______________________________________________________________ DAY / MONTH / YEAR
____ / ____ / ______