BERTH Certificate Registration Application

BERTH Certificate Registration Application

Please complete this form to apply for a BERTH Certificate under EITN. All sections are required for processing.
Applicant Full Name*

First NameLast Name
Applicant Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Berth / Vessel Name or ID*
Berth Location*
Type of Application*
Intended Use of Berth*
Berth Dimensions / Specifications*
Vessel Registration CertificateEIN Number- 508c1a
Upload Supporting Documents*

Cancelof
Declaration / Agreement*
Applicant Signature*

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Date*

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Date

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TribalBERTH Registration & Record Filing

The BERTH Registry serves as the official master record of all registered births (BERTH Certificates) within the Etheric Indigenous Tribal Nation. This ledger preserves lineage, establishes record authenticity, and provides verification of issued certificates.

To complete registration and official documentation, the following fees apply:

Tribal BERTH Registration & Record Filing: $75

(Includes application review, record creation, and archival)

Official BERTH Certificate Issuance: $50

(Includes preparation of ceremonial certificate document)

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$125.00 Quantity

Total

$0.00

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