Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Trumb Signature Voting Full Name: *Father’s Name: *FirstMiddleLastMother’s Name: *FirstMiddleLastCurrent Address: *Address Line 1CityState / Province / RegionElectoral District #: *Sex/Gender:MaleFemaleVoting Center Locality *Height:Voting Center Code: *Date of Birth: *Place of Birth:Marital Status:SingleMarriedSeparatedDivorcedWidow(er)If married, Spouse Name:Contact Number: *Email Address: *Do you hold citizenship of another country?NoYesIf Yes Country Name:*Have you resided in another country for more than 2 years? NoYesIf Yes Country Name:Status:Card Type: National ID cardNational ID Card (ECOWAS)Documents Attached to Application FormPassportVoter IDBirth CertificateNaturalization CertificateOthersIntroducer Information [To be used only if requested by the NIR]Full Name:FirstMiddleLastNIN No:Contact Number: DISCLAIMERI hereby declare that the information provided herein are true and correct to the best of my knowledge. NOTE: you could be prosecuted forperjury or attempt to falsify Liberian Citizenship if your information is not true and correctApplicant’s Signature / Trumb PrintDate:Immigration Officer SignatureNIR Officer Signature & StampSubmit
