Please read the following instructions carefully before completing this application form. |
INSTRUCTIONS | | DOCUMENT CHECK LIST – The following documents are required from the alien: |
1. This form must be used to make an application for a Certificate of Eligibility to be eligible to make an application for an Alien Landholding Licence. | | 1. This application form must be accompanied by all requisite documentation for a Certificate of Eligibility. |
| 2. Proof of payment of the non-refundable application fee for a Certificate of Eligibility. |
2. In a case where an application is made by an alien that is a company, a director, shareholder or beneficial owner may fill out the application on behalf of the company. | |
| 3. Birth certificate or birth record. |
| 4. In the case of a name change, an alien must provide a certified copy of the name change document, for example, a Deed Poll or Adoption papers. In the case of a company, a certified copy of the merger or amalgamation agreement must be provided. |
3. Items 1.4 to 1.8, 2.1 and 2.3 do not apply to an alien that is a company. | |
4. This application form must be completed in the English Language and must be submitted in BOTH electronic and printed form. | |
| 5. Two (2) passport-sized color photographs of the alien taken within the last six (6) months certified as the true likeness of that alien. |
5. All supporting documents submitted with this application form must be in the English Language or an authenticated translation in the English Language. | |
| 6. A certified copy of the passport bio-data page. |
An “authenticated translation” means a translation effected by either a professional translator who is officially accredited by a court of law, a government agency, an international organization or similar institution, or if effected in a country where there are no official accredited translators, a translation effected by a company whose role or business is effecting professional translations. | | 7. Proof of residential address valid within the last three (3) months immediately preceding the submission of the application. (E.g. an original copy of a recent Utility Bill OR Bank Statement showing the full name and address. In the case of a company, a Notice of Address must be provided. |
| 8. An original Bank Reference Letter issued by an internationally recognized financial institution within the last six (6) months preceding the submission of the application form. |
A copy of the credentials or professional certificate(s) of the translator must be presented. | |
| 9. An original Police Certificate of Good Character or its equivalent from the alien's country of residence and if not the same, from his or her country of nationality. |
6. Where a document is required to be submitted, either the original or a certified copy must be provided. A “certified copy” means a photocopy or facsimile of the original document certified by a Notary Royal, an Attorney-at-Law or the Commissioner of Oaths to be a true copy of the original. | |
| 10. In the case of an alien that is a company, a director, beneficial owner and shareholder with at least twenty-five per cent (25%) shares in the company must submit the documentation required at items 2 to 8 above. |
7. Note that an application can only be accepted and processed if this application form is properly completed, dated and signed. | |
| 11. In the case of an alien that is a company, this application must be accompanied by — |
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| | (a) a certified copy of the Certificate of Incorporation or Certificate of Registration; |
| | (b) a Certificate of Good Standing or its equivalent from the country the company was incorporated or registered; |
| | (c) a certified copy of filed corporate documents; |
| | (d) a notice of the directors, beneficial owners or shareholders of the company. |
| | 12. A copy of the register of land currently owned in Saint Lucia, if applicable. |
| | 13. A statutory declaration verifying the contents of the application. |
Part 1 – General |
I am completing this form as an | | Individual | | Company |
| | I am applying for a Certificate of Eligibility for one (1) year. |
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| | I am applying for a Certificate of Eligibility for ten (10) years. |
1. PERSONAL/COMPANY DETAILS |
1.1 (a) Full name (as shown on your birth certificate). Confirmation of your full name (certified copy of full birth certificate OR excerpt of full birth record) |
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| Last Name (family name) | First/Given Name |
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| Middle Name(s) | Other Name(s) |
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1.1 (b) | Company name | Company number |
1.2 Current name, if different from above |
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| Last Name (family name) | First/Given Name |
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| Middle Name(s) | Other Name(s) |
1.3 Method of name change: |
(a) in the case of an individual: | | Marriage | | Deed Poll |
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| | Adoption | | Other |
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(b) in the case of a company: | | Merger | | Amalgamation |
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| | Other |
(Note: You must provide supporting documents for proof of any change of name, such as, a Deed poll, adoption papers, merger or amalgamation agreement or other document.) |
1.4 Name in Ethnic Script |
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1.5 Date of Birth (DD/MM/YYYY) | 1.6 Place and Country of Birth |
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1.7 Gender | 1.8 Citizenship at birth |
1.9 Complete for all your current passports | Complete for each additional passport you hold. Attach additional pages, if required. |
Passport 1 | Passport 2 | Passport 3 |
Issuing country |
Passport Number |
Place of issue |
Date of issue |
Date of expiration |
1.10 Contact Information |
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Home Telephone Number | Mobile Telephone Number | Facsimile Number | Other Telephone Number |
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Email Address | |
1.11 Current Address/Registered address of the company (NOTE: An individual MUST provide proof of his or her current residence by a certified copy OR recent Utility Bill OR Bank Statement showing his or her full name and address and in the case of a company the last filed Notice of Address). |
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Street Address | City | State |
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Country | Zip Code | |
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Date since residing at current address | | |
(DD/MM/YYYY) | | |
1.12 Permanent Residential Address (if different from current address) |
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Street Address | City | State |
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Country | Zip Code | |
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Date since residing at permanent address | | |
(DD/MM/YYYY) | | |
1.13 Please provide an address in Saint Lucia for service of correspondence |
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2. INCOME AND SOURCE OF WEALTH OF THE PRINCIPAL APPLICANT |
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2.1 Are you self-employed? | | Yes | | No | |
If yes, please complete the following section 2.2 with the details of your primary business |
2.2 Details of your primary business |
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| Name of Business | Nature of Business |
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Registered Address of Business |
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| Business Website Address | Business Telephone Number | Business Facsimile Number |
If not applicable, please complete the following section with the details of your employer. |
2.3 Details of employer's business |
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| Name of Employer | Nature of Employer's Business |
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Registered Address of Employer's Business |
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| Employer's Business Website Address | Employer's Business Telephone Number | Employer's Business Facsimile Number |
2.4 What is your main source of income? |
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2.5 What is the main geographic jurisdiction(s) in which you conduct business? |
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2.6 What is your estimated gross annual income in US Dollars? |
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3. ALIEN INVESTOR ENTRANCE PERMIT |
3.1 (a) Further to completing the application, do you wish to apply for an Alien Investor Entrance Permit? |
| YES | | |
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| NO | | |
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3.1 (b) In the case of an alien that is a company: Who is applying for an Alien Investor Entrance Permit? |
| Number of persons | | a director |
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| Number of persons | | a shareholder |
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| Number of persons | | a beneficial owner |
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| Number of persons | | a dependant of a director, shareholder or beneficial owner |
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3. (a) DECLARATION |
To be filled out by the alien and, in the case of an alien that is a company, by each director, shareholder, beneficial owner and each dependent of an alien. |
| Yes | No |
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4.1 Have you ever been arrested, detained, charged or been expunged of any offence(s) in any country? | | | | | | |
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4.2 Have you ever been sentenced to serve a period of time in detention or been on probation? | | | | | | |
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4.3 Have you ever been involved, directly or indirectly, in the financing of terrorism or in any terrorist or criminal organization? | | | | | | |
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4.4 Have you ever been the subject of an order, judgement or decree of a federal or state authority barring, suspending, or otherwise limiting your right to engage in a professional, business practice or activity? | | | | | | |
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4.5 I confirm that my wealth has been obtained from completely legitimate sources, and is not, whether directly or indirectly, from the proceeds of criminal activity of any kind. | | | | | | |
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4.6 If you have answered yes to any declaration between 4.1 to 4.4, please provide a full explanation below. | | | | | | |
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3. (b) DECLARATION |
Please ensure that the information provided is true and correct. If you have provided false information or omitted information, your application for a Certificate of Eligibility may be denied under the Alien Landholding (Licensing) Act, No. 1 of 2020 and you may face criminal prosecution. |
I certify that I have read and understood all the questions in this application form and that the information provided, whether supplied directly by myself or through an attorney-at-law completing this application form on my behalf, is true and up-to-date in every detail. |
I authorize, without reservation, the Citizenship by Investment Unit ('the Unit') to verify any personal information about me. Accordingly, I also authorize the Unit, either directly or through an agent that the Unit may choose to engage, to decide to obtain further information, credit reports, criminal records or any kind of records about me that the Unit considers necessary. |
I understand that such information, records and reports may be obtained from online sources, government agencies or private sources. |
I also authorize an agent contacted by the Unit to furnish the requested information, reports or records about me, and I release all parties involved from any responsibility and liability in doing so. |
Accordingly, I also authorize the release by the Unit of any personal information about me given in this application or otherwise obtained by the Unit in order to verify such information or obtain such reports or records about me, which may assist the Unit in deciding whether my application for a Certificate of Eligibility will be granted. |
If there is any change in my circumstances which may affect the information that I have given in this application, I confirm that I will advise, in writing to the Unit, for the interim period between the date of this application and the date of the grant or denial of the application for a Certificate of Eligibility. |
If the Certificate of Eligibility is granted to me, I do solemnly pledge that: |
(a) I will always faithfully observe the laws of Saint Lucia; and |
(b) I will conduct myself in a manner that does not bring disrepute to Saint Lucia. |
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(Place) | (Date) | (Signature of applicant) / (Signature of director / shareholder or beneficial owner on behalf of company) |