document for BGLT Asylum seekers.  

to obtain a asylum from the Templar Kingdom for the duration of 1 year purpose only, each year this visa needs to be renewed!

 [following the netherlands example]

• each person who seeks asylum, needs to fill in one form.

fill in with a blue pen, in blockletters and for a zero write:ø (with a line trough it

Asylum document

Last name(s):____________________________________ 

First name(s):____________________________________

Sex:         O Male  O Female

Passport #:______________________________________

Colour eyes:_____________________________________

Colour hair:______________________________________

Date of Birth:_____________________________________

Place of Birth:____________________________________

Citizenship:______________________________________

Are you one of the following: (put an X or a V throught circle)

O Bisexual

O Gay   

O Lesbian     

O Transexual

Have you been attacked?

O yes

O No

Have you got a police report

O yes (bring it with you)

O No

Have you been raped?

O yes

O no

Have been threatened with death?

O yes

O no

save-housing location:

house/room number:_____________________________

name building:_________________________________

adress:_______________________________________

postal code:___________________________________

City:_________________________________________

room shared with:

Name:_________________________________________

telephone #:____________________________________

Contact person in case of emergency

Name:_________________________________________

adress:________________________________________

relation to you:__________________________________

postal code:_____________________________________

city:___________________________________________

telephone #:_____________________________________

I,_________________________________________ swear that all information in this report is true, and that I will show proof of it. I know that if I give false inforation under oath, my right to assylum will indefinately be revoked.

(GLA-EN)

attach: 1 colour photo.

send the filled in application to: ginoscorpio@hotmail.com

when you recieve this asylum Document, put it into you passport, and leave it in there for the duration of your stay and always have your passport on your person at all times when in the country! (a photo copy of passport and this document is not excepted as means of identification. Immediate deportation may be enforced in case of invalid travel documents.)