| I am completing this form as a Principal Applicant YES No |
| If you are completing the Application as a Spouse or Dependant of a Principal Applicant, please complete Form SL-2B. |
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| 1. APPLICANT DETAILS |
| 1.1 Your full name as shown on your birth certificate. |
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| Family Name or Surname | First Name |
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| Middle Name | Other Name(s) |
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| Place of Birth | Country of Birth | Date of Birth (DD/MM/YYYY | Gender |
| 1.2 Permanent Address |
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| Street Address | City | Zip Code |
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| Country | |
| 1.3 Passport Details |
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| Issuing Country | Passport Number |
| 1.4 Contact Information |
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| Mobile Telephone Number | Home Telephone Number |
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| Email Address | LinkedIn Profile |
| 1.5 Contact information for a person other than the applicant: |
| Name | Relation to the applicant |
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| Email Address | Physical address |
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| Telephone | |
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| 2. USE OF AUTHORIZED AGENT |
| This Section should be completed by the Principal Applicant ONLY. If you are a spouse OR Dependant of a Principal Applicant, go to Section 4. |
| ONLY an Authorized Agent can apply on your behalf. |
| • I authorize the following individual or entity to serve as my authorized agent and to act on my behalf with the Citizenship by Investment Unit of Saint Lucia. |
| • I authorize the Citizenship by Investment Unit of Saint Lucia to release information from my case file and that of my spouse and dependant children to my authorized agent as may be necessary. The authorization is in accordance with the Data Protection Act, Cap 8.18. |
| • I am aware that any information which would be subject to exemption, if I had the right of access under the Data Protection Act, will likely not be released. |
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| Name of Authorized Agent | Authorized Agent Licence Number |
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| Authorized Agent Address in Full |
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| Business Telephone Number | Mobile Telephone Number |
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| Email Address | |
| Promoter who Referred Applicant | Promoter Licence Number |
| *Please write N/A if you did not get a referral From a Promoter. | |
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| Marketing Agent who Referred Applicant | Marketing Agent Licence Number |
| *Please write N/A if you did not get a referral From a Marketing Agent | |
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| Place | Date | Signature of Authorized Agent |
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| 3. INVESTMENT CONFIRMATION |
| A qualifying investment under the Citizenship by Investment Programme must satisfy at least the minimum investment in the chosen option. Tick the investment option you have chosen. |
| INVESTMENT OPTION | MINIMUM QUALIFYING INVESTMENT (USD) |
| The Saint Lucia National Economic Fund | $100,000 |
| An Approved Real Estate Project | $200,000 |
| An Approved Enterprise Project | Option 1: $3,500,000 |
| | Option 2: $6,000,000 |
| | Option 3: $100,000 |
| Government Bond | $300,000 |
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| 4. PERSONAL DETAILS |
| 4.1 Have you changed your name since birth? Yes …. No |
| If yes, please state the method used to change your name |
| Marriage Deed Poll Adoption Other |
| Insert your new legal name below. You must submit one supporting documents for proof of name change e.g Deed Poll; Adoption Papers etc. |
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| Family Name (Last Name) | First Name |
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| Middle Name | Other Name(s) |
| 4.2 Please write your name as it is written in Ethnic Script in the space below. |
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| Please note that should citizenship be granted, a name change will not be permitted within five (5) years. |
| 4.3 Do you hold, or have you ever held any other citizenship? …Yes No |
| If yes, please specify the country or countries and how you acquired citizenship. List any dates of changes in citizenship including the place at which such changes were recorded. Provide proof of any other citizenship by submitting a Certificate of Citizenship. |
| Country or Territory of Citizenship | Date of Citizenship | Explanation |
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4.4 Do you hold, or have you ever held permanent residency in any country?
Yes No |
| If yes, please specify the country or countries and how you acquired permanent residency. List any dates of any changes of permanent residency including the place at which such changes were recorded. Proof of permanent residency is a Permanent Resident Card or Certificate. |
| Country or Territory of Citizenship | Date of Permanent Residency | Explanation |
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| 4.5 Have you ever served in the armed forces? … Yes No |
| If yes, please provide details including branch, date of entry, and separation and ranking at the time of separation. Proof of service in the armed forces is a Certified Copy of your military record. |
| Branch | Date of Entry | Date of Separation | Rank at Separation |
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| 5. IDENTIFICATION INFORMATION |
| Provide two passport-sized, coloured photographs of yourself taken within the last 6 months. Refer to the Document Checklist for details on the passport requirements. |
| 5.1 What is your natural eye color? ..Blue Grey Brown Green Black |
| Other |
| 5.2 What is your height? … cm or ft. in. |
| 5.3 Do you have any distinguishing marks? …Yes No |
| If yes, describe below. |
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| 5.4 What are your social security details? |
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| Social Security Number | Issuing Country |
| 5.5 National Identification Card Details (Attach a certified copy of your National Identification Card, if applicable) |
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| Identification Card Number | Issuing Country | Expiry Date |
| 5.6 Passport Details (Attach certified copies of ALL your valid passports). |
| Complete for passport issued by your country of birth | 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 | | | |
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| 5.7. Current Address (You MUST provide proof of your current residential address. Proof of residence includes an original utility bill, lease agreement, bank statement with address) |
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| Street Address | City | Zip Code |
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| Country | |
| 5.8 List all the addresses where you have lived for the last 10 years. Please ensure that there are no gaps in your residential history. |
| From (DD/MM/YYYY) | Apt/Unit | Street No. | Street Name | City/Town |
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| 1 | | Country/Territory | Prov/State | Postal Code | District |
| PRESENT | | | | |
| 2 | From (DD/MM/YYYY) | Apt/Unit | Street No. | Street Name | City/Town |
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| To (DD/MM/YYYY | Country/Territory | Prov/State | Postal Code | District |
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| 3 | From (DD/MM/YYYY) | Apt/Unit | Street No. | Street Name | City/Town |
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| To (DD/MM/YYYY | Country/Territory | Prov/State | Postal Code | District |
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| 4 | From (DD/MM/YYYY) | Apt/Unit | Street No. | Street Name | City/Town |
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| To (DD/MM/YYYY | Country/Territory | Prov/State | Postal Code | District |
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| 5.9 In the past ten (10) years, have you lived in any country other than your birth country for a period of 365 days or more? ..Yes ..No |
| If yes, list every country or territory in the table below. You must provide a police certificate for each country or territory where you have been present for at least a year for the last ten (10) years. If you cannot get a police certificate, tell us why below. |
| The police certificate must either have been issued — |
| • After the last time you were in that country or territory; or |
| • No more than 6 months before the date you submit your citizenship by investment application. |
| Use additional paper if required. |
| Country or Territory | I will provide a Police Certificate | Explanation |
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| 6. FAMILY INFORMATION |
| 6.1 Your marital status? |
| Never Married Married Divorced Separated Widowed |
| Engaged |
| If married, please attach a certified copy of your Marriage Certificate. |
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| Date of Marriage | Place of Marriage (City/Town/Country or Territory |
| If divorced, please attach a certified copy of your Divorce Decree. |
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| Date of Divorce | Place of Divorce (City/Town/Country or Territory |
| 6.2 Spouse Personal Details, if applicable. |
| Is your spouse included in this application? Yes No |
| If no, complete the information below: |
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| Spouse's Full Name (after marriage) | Spouse's Full Name (before marriage) |
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| Last Name (Surname) | First Name |
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| Middle Name | Other Name(s) |
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| Place of Birth | Country of Birth | Date of Birth (DD/MM/YYYY) | Gender |
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| Spouse's Occupation | Spouse's Email Address |
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| Spouse's Nationality | Spouse's Passport Number |
| 6.3 Spouse's Residential Address, if different from your residential address. |
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| Street Address | City | Zip Code |
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| Country | Date since residing at address (DD/MM/YYYY) |
| 6.4 Father's Personal Details. |
| Is your father included in this application? Yes No |
| If no, complete the information below: |
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| Father's Last Name (Surname) | Father's First Name (Given Name) |
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| Father's Middle Name(s) | Father's Other Name(s) (Known As) |
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| Place of Birth | Country of Birth | Date of Birth (DD/MM/YYYY |
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| Father's Occupation | Father's Email Address |
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| Father's Nationality | Father's Passport Number |
| 6.5 Father's Residential Address, if different from your residential address. |
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| Street Address | City | Zip Code |
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| Country | Date since residing at address (DD/MM/YYYY |
| 6.6 Mother's Personal Details. |
| Is your mother included in this application? Yes No |
| If no, complete the information below: |
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| Mother's Last Name (Surname) | Mother's First Name (Given Name) |
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| Mother's Middle Name(s) | Mother's Other Name(s) (Known As) |
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| Place of Birth | Country of Birth | Date of Birth (DD/MM/YYYY |
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| Mother's Occupation | Mother's Email Address |
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| Mother's Nationality | Mother's Passport Number |
| 6.7 Mother's Residential Address, if different from your residential address. |
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| Street Address | City | Zip Code |
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| Country | Date since residing at address (DD/MM/YYYY) |
| 6.8 Children's Personal Details. (Complete for all biological, adopted and stepchildren. Attach additional pages as required) |
| Is your child included in this application? Yes No |
| If no, complete the information below: |
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| Child's Last Name (Surname) | Child's First Name (Given Name) |
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| Child's Middle Name(s) | Child's Other Name(s) (Known As) |
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| Place of Birth | Country of Birth | Date of Birth (DD/MM/YYYY) |
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| Child's Occupation | Child's Email Address |
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| Child's Nationality | Child's Passport Number |
| 6.9 Child's Residential Address, if different from your residential address. |
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| Street Address | City | Zip Code |
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| Country | Date since residing at address (DD/MM/YYYY) |
| 6.10 Sibling's Personal Details. (Complete for all siblings including half, step, and adopted. Attach additional pages as required) |
| Is your sibling included in this application? Yes No |
| If no, complete the information below: |
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| Sibling's Last Name (Surname) | Sibling's First Name (Given Name) |
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| Sibling's Middle Name(s) | Siblings' Other Name(s) (Known As) |
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| Place of Birth | Country of Birth | Date of Birth (DD/MM/YYYY) |
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| Sibling's Occupation | Sibling's Email Address |
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| Sibling's Nationality | Sibling's Passport Number |
| 6.11 Sibling's Residential Address, if different from your residential address. |
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| Street Address | City | Zip Code |
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| Country | Date since residing at address (DD/MM/YYYY) |
| 6.12 Previous Spouse Personal Details, if applicable. (Attach additional pages if necessary) |
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Previous Spouse's Full Name
(after marriage) | Previous Spouse's Full Name
(before marriage) |
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| Place of Birth | Country of Birth | Date of Birth (DD/MM/YYYY) | Gender |
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| Date of Divorce Order/Decree | Duration of Marriage
(number of months/years) |
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| 7. INCOME AND SOURCE OF WEALTH |
| (a) What is your occupation |
| (b) Are you self-employed? Yes No |
| If yes, please complete the following section 7.1 below. |
| If no, with the details of your primary business. If no, skip 7.2 and please complete section 7.2 |
| 7.1 Details of your primary business, if applicable. |
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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 LinkedIn URL |
| 7.2 Details of Employer's Business, if applicable. (Attach a Curriculum Vitae and Employment Letter or Contract as proof of employment) |
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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 Website Address | Employer's Telephone Number | Employer's LinkedIn |
| 7.3 What is your main source(s) of income? |
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| 7.4 What is the main geographical jurisdiction(s) in which you work/conduct business? |
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| 7.5 What are the most frequent companies or persons with whom you do business? |
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| 7.6 List all the companies of which you are currently a director or shareholder. |
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| 7.7 What is your estimated gross annual income in USD? |
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| 7.8 Please provide the personal bank account details from which you will be sending funds to the Citizenship by Investment Board. |
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| Name of Account Holder | IBAN/BIC Code | Account Number |
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| Bank Name and Address |
| 7.9. Please provide the banking details of any other account you may use for sending funds to the Citizenship by Investment Board. |
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| Name of Account Holder | IBAN/BIC Code | Account Number |
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| Bank Name and Address |
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| 8. EDUCATION & PROFESSIONAL CERTIFICATION |
| Please list all the schools or training institutions attended from the age of 18 and all qualifications obtained up to the highest level of education you successfully completed. (Proof of qualifications is Professional and Academic Certificates. |
| Start MM/YY | End MM/YY | Name of Institution | Address of Institution | Qualification Achieved |
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| 9. DECLARATIONS |
| | Yes | No |
| 9.1 | Excepting a minor offence, have you ever been — | | |
| [ ] arrested | | |
| [ ] detained | | |
| [ ] charged | | |
| [ ] indicted | | |
| [ ] convicted | | |
| [ ] found guilty | | |
| [ ] had a criminal record expunged? | | |
| 9.2 | Have you ever been denied any category of visa to a country with which Saint Lucia has visa free access and have not been successful in subsequently obtaining such a visa? | | |
| 9.3 | Have you ever had a visa cancelled or have been unlawfully present in or deported from ANY country or sought to assist others to do the same? | | |
| 9.4 | Have you ever been declared bankrupt by a court? | | |
| If yes, note date, city, state, and country in which the court declared you bankrupt. | | |
| 9.5 | Have you ever been involved personally, or as a director, in any bankruptcy, insolvency or liquidation proceedings? | | |
| 9.6 | Have you ever testified before a grand jury or investigative hearing or probe? | | |
| 9.7 | Have any charges, or accusations of illegal activity of any nature been made against you in any country? | | |
| 9.8 | Have you ever been the subject of a criminal investigation? | | |
| 9.9 | Have you ever been considered a potential national security risk in any country? | | |
| 9.10 | Have you ever been sentenced to serve a period in detention or been on probation? | | |
| 9.11 | Have you ever received a pardon for a criminal offence? | | |
| If yes, note that date, city, county, state, and country in which you received the pardon. | | |
| 9.12 | Have you ever had a civil or criminal record expunged or sealed by a court order? | | |
| 9.13 | Have you ever been subpoenaed to appear to testify before a federal, state or county grand jury, board, or commission? | | |
| 9.14 | Has a criminal indictment, information or complaint even been returned against you, but for which you were not arrested or in which you were named as an in-indicted co-party? | | |
| 9.15 | Have you, as an individual, or as an owner, partner, director or officer of any partnership, corporation, or entity, ever been a party of a lawsuit as either a plaintiff or defendant? (Other than divorce)? | | |
| 9.16 | Have you ever been involved, directly or indirectly, in the financing of terrorism or in any terrorist or criminal organization? | | |
| 9.17 | Have you ever been unlawfully present in or been deported from any country, or sought to assist others to do the same? | | |
| 9.18 | Have you ever applied for citizenship or residency in any country for which the citizenship or residency has NOT been granted? | | |
| 9.19 | Have you ever been the subject of any order, judgement or decree of any federal or state authority barring, suspending, or otherwise limiting your right to engage in any professional or business practice or activity? | | |
| 9.20 | Are you a politically exposed person (PEP)? | | |
| (A PEP may be past or current government office holders, or individuals who are or were formerly entrusted with high-level public functions. For example, senior officers, heads of state of government, senior judicial or military officers, officials of political parties and senior executives of state-owned enterprises (SOE). PEP definition includes family members and close associates of a primary PEP). | | |
| 9.21 | Have you ever been declared by a court or a qualified health practitioner to be mentally incapacitated? | | |
| 9.22 | Are there any other business activities in which you are engaged that have not already been disclosed on this form? | | |
| 9.23 | To the best of your knowledge, have you ever been under investigation by any law enforcement agency or tax authority in any country? | | |
| 9.24 | 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. | | |
| 9.25 | I can confirm that I am fully compliant with my national, regional, and global tax obligations. | | |
| If you have answered “yes” to any of the questions other than 9.24 or 9.25 please provide further details. Clearly indicate that number for which the details are being provided in each case. Attach additional sheets as required. |
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| 10. DATE AND SIGNATURE |
| I certify that I have read and understood all questions in this form and that the information provided, whether supplied directly by myself or through an Authorized Agent or third party completing the form on my behalf, is true and current in every detail. |
| I herewith authorize, without reservation, the Citizenship by Investment Unit of Saint Lucia (“the Unit”) to verify any personal information about me and/or my dependants, where an application has been made in respect of my dependants. Accordingly, I also authorize the Unit, either directly or through any agents that the Unit may choose to engage, to obtain further information, credit reports, criminal records, or any kind of records which may be obtained from online sources, government agencies or private sources. I authorize any agents contacted to furnish the requested information, reports, or records about me and/or my dependants 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 and/or my dependants given on this form or otherwise obtained by the Unit to verify such information or obtain such reports or records and me and/or my dependants, which may assist the Unit in deciding whether I and/or my dependants qualify for citizenship inclusive of whether the source of my funds are legitimate to determine whether my qualifying investment can be accepted by financial institutions in Saint Lucia. |
| I understand that becoming a citizen of Saint Lucia may affect my current citizenship status. |
| If there is any change in my circumstances which may affect that information that I have given in this application, I confirm that I will advise, in writing to the Citizenship by Investment Unit, for the interim period between the date of this application and the date of granting citizenship. |
| If citizenship of Saint Lucia is granted to me, I do solemnly pledge that — |
| • I will always faithfully observe the laws of Saint Lucia. |
| • I will conduct myself in such a manner which at no time will bring disrepute to Saint Lucia. |
| • I will not act against the interest of Saint Lucia. |
| • I will be faithful and bear true allegiance to His Majesty King Charles, His Heirs, and Successors, according to the law. |
| I herewith apply to be granted citizenship of Saint Lucia. |
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| Place | Date | Signature of Applicant |
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| 11. DECLARATION |
| I hereby declare that all the information I have provided is true and correct and if I have provided false information or omitted information, I understand that my citizenship application may be denied. If it is later found out that I have provided false or incorrect information, I understand that my Saint Lucian citizenship will be revoked pursuant to Section 38(1) of the Citizenship by Investment Act, and I may be criminally prosecuted. |