| SL 5 |
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| General Information: |
| Please read the following explanatory notes carefully before completing your application form: |
| 1. This form is to be used for making an application to be registered as a citizen of Saint Lucia under section 30 of the Citizenship by Investment Act, No. 14 of 2015. |
| 2. All applications must be submitted by a licensed authorised agent. |
| 3. This form is to be completed in English and must be submitted in BOTH electronic and printed form. |
| 4. If more than one person applies, either as a couple or as a family, one form for each person (including children) is to be completed. |
| 5. This form MUST be completed by the principal applicant, as well as each accompanying qualifying dependent. |
| 6. Where indicated, each form should be signed personally except in the case of a child below the age of 18 years or where the qualifying dependent is physically or mentally challenged. |
| 7. For a child who is below the age of 18 years, both parents may be required to sign the forms on behalf of the child as their legal guardians. |
| 8. In the event that one parent has sole custody of the child only that parent seeking citizenship will be required to sign the form and the appropriate documentation MUST be provided as evidence of custody. |
| 9. In the event that another person is a legal guardian of the child, appropriate documentation must be provided as evidence of guardianship and that individual will also be required to sign the form. |
| 10. In the cases of 6, 7, 8 and 9 above, an Affidavit from the non-accompanying parent(s) of the child indicating that they have no objection to their child becoming a Saint Lucian citizen, MUST be attached to the child's form along with a certified true copy of a photo ID bearing the signature of the non-accompanying parent(s). |
| 11. Note that if it is deemed necessary, you may be required to attend an interview in Saint Lucia or at an Embassy or High Commission of Saint Lucia. In case an interview is required, you will be notified through your authorised agent in due course after you have submitted your application. |
| 12. All supporting documents submitted with the application must be in the English Language or an authenticated translation into the English Language. |
| An “authenticated translation” means a translation effected by either a professional translator who is officially accredited to a court of law, a government agency, an international organization or similar official 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. |
| 13. 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, Attorney-at-Law or Commissioner of Oaths to be a true copy of the original. |
| 14. A copy of the credentials or professional certificate(s) of the translator, notary, Attorney-at-Law or Commissioner of Oaths who translates or certifies a document, must be presented. |
| 15. Where original documents or certified copies of original documents that have been issued by a third country are presented, in the case of countries that are parties to the Hague Convention, the translated documents with the original or certified copy of the original document must be authenticated by an Apostille, in accordance with the provisions of the Hague Convention. In the case of countries that are not parties to the Convention, a seal or stamp indicating an authenticated translation may be accepted. |
| 16. Applicants over the age of 16 years MUST provide a police certificate (sometimes also referred to as a “police clearance certificate” or “certificate of no criminal record”) from a national law enforcement authority (usually the police or a department of the Ministry of Justice or a similar government body) that confirms that the applicant has no criminal record. A police certificate MUST be from his or her country of birth and any country where he or she has resided for over one year during the 10 years immediately preceding this application. |
| (a) In most countries police certificates are easily available upon request from a central police/government office. |
| (b) Where the procedure for obtaining police certificates from some countries require that the police authorities will only send the certificate directly to the foreign government requesting the certificate, please |
| 17. Note that applications can only be accepted and processed if: |
| (a) This form is properly completed, dated and signed; |
| (b) This form is accompanied by all requisite documentation; and |
| (c) The non-refundable processing fee and due diligence fee have been paid. |
| The only exceptions are police certificates which may be handed in separately. See 17b above). |
| 18. Original application forms MUST be submitted. Photocopies of completed application forms are not acceptable. |
| INSTRUCTIONS: |
| You must answer all questions on this application form unless indicated otherwise. |
| Download and fill out the application form on a computer. |
| You have the option of saving your form and completing it later. |
| I am completing this form as a: |
| Principal Applicant |
| Spouse of a Principal Applicant |
| Qualifying dependent of a Principal Applicant |
| SECTION A: PERSONAL DETAILS |
| A1. Your 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). |
| Last name (family name) | First name (given name) |
| Middle name(s) | Other name(s) |
| A2. Your current name, if different from above. |
| Last name (family name) | First name (given name) |
| Middle name(s) | Other name(s) |
| A3. Method of name change (Note: you must provide supporting documents for any change in your name. Proof of name change (Deed poll; adoption papers, etc.) |
| Marriage |
| Deed Poll |
| Adoption |
| Other |
| Not Applicable |
| A4. Name in Ethnic Script |
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| A5. Gender | Male | | Female | | A6. Date of birth | DD/MM/YY | |
| A7. Place and Country of Birth | A8. Citizenship at Birth |
| | | | |
| A9. 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 any changes of citizenship including the place at which such changes were recorded. Proof of other citizenship (Certificate of Citizenship, National ID or passport) |
|
| A10. 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 current permanent residency (Permanent Resident Card or Certificate) |
|
| A11. Do you have a work permit which enables you to work in any country? |
| | Yes | | No |
| If yes, please list the names of the country or countries in which you are permitted to work. |
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| A12. 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 separation. Proof of service in the armed forces (Certified copy of military record). |
| Branch | Date of Entry | Date of Separation | Rank at Separation |
| | | |
| | | |
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| SECTION B: IDENTIFICATION INFORMATION |
| Provide six passport-sized, colour photographs of yourself taken within the last six months. Refer to the Document Checklist SL1 for details on the photograph requirements. |
| B1. Colour of your eyes | | Blue | | Grey | | Brown | | |
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| | | Green | | Black | | Other |
| B2. Your height OR ft in |
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| B3. Distinguishing marks |
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| B4. Social security number | Issuing country | |
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| B5. National Identification Card Details (Attach a certified copy of your national identification card). |
| ID card number | | Issuing country | | Expiry date | |
| | | | | |
| B6. Driver's Licence Details |
| Driver's licence number | | Issuing country | | Expiry date | |
| | | | | |
| | |
| B7. Passport Details. | Complete for passport issued by your country of birth | Complete for each additional passport you hold. Attached additional pages if required. |
| Attach certified copies of all the pages of your current passport(s). |
| Passport 1 | Passport 2 | Passport 3 |
| Issuing country | | | |
| Passport number | | | |
| Place of issue | | | |
| Date of issue | | | |
| Date of expiration | | | |
| B8. Contact Information |
| Home telephone number | | Mobile number | | Facsimile number | |
| | | | | |
| Email address | | Other telephone number | |
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| B9. Current Address (NOTE: you MUST provide proof of your current residence. Proof of residence (certified copy of a recent utility bill OR bank statement showing full name and address. |
| Street Address | | City | | State | |
| | | | | |
| Country | | Postal/Zip Code | |
| | | |
| Date since residing at current address |
| DD/MM/YYYY | |
| B10. Permanent Residential Address (if different from current address) |
| Street Address | | City | | State | |
| | | | | |
| Country | | Postal/Zip Code | |
| | | |
| Date since residing at permanent address |
| DD/MM/YYYY | |
| B11. List all addresses where you have lived for the last ten years. Please ensure that there are no gaps in your history. |
| From | To | Street Address | City | Postal Code | Country |
| MM/YYYY | MM/YYYY | | | | |
| MM/YYYY | MM/YYYY | | | | |
| MM/YYYY | MM/YYYY | | | | |
| MM/YYYY | MM/YYYY | | | | |
| SECTION C: INFORMATION ABOUT YOUR FAMILY |
| Give details of all family members, whether applying for citizenship or not, including details of legally adopted children. For your spouse and any other qualifying dependent(s) applying for citizenship, please note that in addition to submitting their details on this form, each accompanying dependent MUST complete an Application for Registration as a Citizen of Saint Lucia Form (SL5). |
| In the case of a family member who is deceased, please give their details and write “deceased” in the field “Residential Address.” |
| C1. Marital Status. (Note: you must provide supporting documents for your marital status. Proof of marital status (marriage certificate OR divorce decree) |
| Never Married | | Married | | Divorced | | |
| | | | | | |
| Widowed | | Separated | | Engaged | | |
| If married, please provide details of your marriage. |
| Date of marriage | | Place of marriage |
| DD/MM/YYYY | | City/State/County/Country | |
| C2. Spouse's Personal Details (if engaged, enter details of future spouse) |
Last name (surname)
| First name (given name) |
Middle name(s)
| Other names (known as) |
Spouse's full name (before marriage)
|
Last name (surname)
| First name (given name) |
|
| | | | |
| Gender | Male | | | Date of birth DD/MM/YYYY |
| | |
| Female | | |
| | | |
| Place of birth | Nationality/citizenship | Passport number |
| Spouse's residential address (if different from your residential address). |
| Street Address | | City | | State |
| | | | |
| Country | | Postal/Zip Code |
| | |
| Date since residing at current address |
| DD/MM/YYYY | |
| Spouse's home telephone number (if different from your home number) |
| |
| Spouse's mobile phone number |
| |
| Spouse's occupation |
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| | | | |
| Is your spouse included in this application? | | Yes | | No |
| C3. Previous Spouse's Personal Details (if applicable) |
| Previous spouse's full name (if applicable) |
|
| Place of birth | Date of birth |
| Date of divorce order/decree | Period of marriage (indicate the number of months and years of marriage) |
|
Previous spouse's full name (if applicable)
|
| Place of birth | Date of birth |
| Date of divorce order/decree | Period of marriage (indicate the number of months and years of marriage) |
| C4. Father's Personal Details |
| Father's last name (surname) | Father's first name (given name) |
| Father's middle name(s) | Father's other names (known as) |
|
Father's place of birth
| Date of birth |
| DD/MM/YYYY |
|
Father's nationality/citizenship
| Father's passport number |
| Father's residential address (if different from your residential address). |
| Street Address | | City | | State |
| | | | |
| Country | | Postal/Zip Code |
| | | |
| Date since residing at current address |
| DD/MM/YYYY | |
| Father's home telephone number (if different from your home number) |
| |
| Father's mobile phone number |
| |
| Father's occupation |
|
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| Is your father included in this application? | | Yes | | No |
| C5. Mother's Personal Details |
| Mother's last name (surname) | Mother's first name (given name) |
| Mother's middle name(s) | Mother's other names (known as) |
|
| Mother's place of birth | Date of birth
DD/MM/YYYY |
| Mother's nationality/citizenship | Mother's passport number |
| Mother's residential address (if different from your residential address). |
| Street Address | | City | | State |
| | | | |
| Country | | Postal/Zip Code |
| | |
| Date since residing at current address |
| DD/MM/YYYY |
| Mother's home telephone number (if different from your home number) |
| |
| Mother's mobile phone number |
| |
| Mother's occupation |
|
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| Is your mother included in this application? | | Yes | | No |
| C6. Children's Personal Details (Complete for all biological, adopted and step children. Attach additional sheets if required) |
| Child's last name (surname) | Child's first name (given name) |
| Child's middle name(s) | Child's other names (known as) |
| Gender | Male | Date of Birth
DD/MM/YYY |
| Female | |
Child's place of birth
| Child's nationality/ citizenship | Child's passport number |
| Child's residential address (if different from your residential address). |
| Street Address | | City | | State |
| | | | |
| Country | | Postal/Zip Code |
| | |
| Date since residing at current address |
| DD/MM/YYYY | |
| Child's occupation (please insert student if the child is still attending school) |
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|
| Is this child included in this application? | | Yes | | No |
|
| Child's last Surname | Child's first name (given name) |
| Child's middle name(s) | Child's other names (known as) |
| |
| Gender | Male | | | Date of birth
DD/MM/YYYY |
| | |
| Female | | |
| | | |
| Child's place of birth | Child's nationality/citizenship | child's passport number |
| Child's residential address (if different from your residential address). |
| Street Address | | City | | State |
| | | | |
| Country | | Postal/Zip Code |
| | |
| Date since residing at current address |
| DD/MM/YYYY | |
| Child's occupation (please insert student if the child is still in school) |
|
|
| Is this child included in this application? | | Yes | | No |
|
| Child's last name (surname) | Child's first name (given name) |
| Child's middle name(s) | Child's other names (known as) |
| |
| Gender | Male | | | Date of birth
DD/MM/YYYY |
| | |
| Female | | |
| | | |
| Child's place of birth | Child's nationality/ citizenship | Child's passport
number |
| Child's residential address (if different from your residential address). |
| Street Address | | City | | State |
| | | | |
| Country | | Postal/Zip Code |
| | |
| Date since residing at current address |
| |
| Child's occupation (please insert student if the child is still in school) |
|
|
| Is this child included in this application? | | Yes | | No |
| C7. Brother's & Sister's Personal Details (Complete for all siblings, including half, step and adopted. Attach additional sheet if required) |
| Sibling's last name (surname) | Sibling's first name (given name) |
| Sibling's middle name(s) | Sibling's other names (known as) |
| |
| |
| Gender | Male | | | Date of birth
DD/MM/YYYY |
| | |
| Female | | |
| | | |
| Sibling's place of birth | Sibling's nationality/citizenship | Sibling's passport number |
| Sibling's residential address (if different from your residential address). |
| Street Address | | City | | State |
| | | | |
| Country | | Postal/Zip Code |
| | |
| Date since residing at current address |
| DD/MM/YYYY | |
| Sibling's home telephone number |
| if different from your home number) |
| |
| Sibling's mobile phone number |
| |
| Sibling's occupation |
|
|
| Sibling's last name (surname) | Sibling's first name (given name) |
| Sibling's middle name(s) | Sibling's other names (known as) |
| |
| |
| Gender | Male | | | Date of birth
DD/MM/YYYY |
| | |
| Female | | |
| | | |
| Sibling's place of birth | Sibling's nationality/citizenship | Sibling's passport number |
| Sibling's residential address (if different from your residential address). |
| Street Address | | City | | State |
| | | | |
| Country | | Postal/Zip Code |
| | |
| Date since residing at current address |
| |
| Sibling's home telephone number (if different from your home number) |
| |
| Sibling's mobile phone number |
| |
| Sibling's occupation |
|
| Sibling's last name (surname) | Sibling's first name (given name) |
| Sibling's middle name(s) | Sibling's other names (known as) |
| |
| |
| Gender | Male | | | Date of birth
DD/MM/YYYY |
| | |
| Female | | |
| | | |
| Sibling's place of birth | Sibling's nationality/ citizenship | Sibling's passport number |
| Sibling's residential address (if different from your residential address). |
| Street Address | | City | | State |
| | | | |
| Country | | Postal/Zip Code |
| | |
| Date since residing at current address |
| DD/MM/YYYY | |
| Sibling's home telephone number (if different from your home number) |
| |
| Sibling's mobile phone number |
| |
| Sibling's occupation |
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| SECTION D: INCOME AND SOURCE OF WEALTH OF THE PRINCIPAL APPLICANT |
| ONLY the principal applicant is required to compete this section. |
| D1. Are you self-employed? | | Yes | | No |
| If yes, please complete the following section D2 with the details of your primary business. |
| D2. Details of your primary business |
Name of business
| Nature of business |
Registered address of business
| Business website address |
Business telephone number
| Business facsimile number |
| If not applicable, please complete the following section D3 with the details of your employer. Proof of employment (Curriculum Vitae) |
| D3. Details of Employer's Business |
Name of employer
| Nature of employer's business |
|
Registered address of employer's business
| Employer's business website address |
Employer's business telephone number
| Employer's business facsimile number |
| D4. Provide the details of all valid and expired professional and privileged licences that you may hold or have held (e.g. real estate, gambling, and financial services) over the last ten years, immediately preceding this application. |
| Licence | Licencing Body | Dates Held |
| | |
| | |
| | |
| D5. What is your main source of income? |
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| D6. What is the main geographical jurisdiction(s) in which you conduct business? |
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| D7. What are the most important companies or persons with whom you do business? |
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| D8. List all the companies of which you are currently a director or shareholder. |
Director
| Shareholder |
| D9. What is your estimated gross annual income in USD? |
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| D10. What is your estimated net worth (personal assets minus personal liabilities) in USD? |
|
| D11. In the table below, please provide the value of your assets and liabilities (NOTE: You must provide a sworn affidavit declaring financial resources of a minimum of US $3,000,000) |
| Assets | Amount | Liabilities | Amount |
| Savings or Deposits | | Outstanding long term loans
(e.g. mortgage, car loan, personal loan etc.) | |
| Fixed assets (property, vehicle, etc.) | | Outstanding short term loans
(e.g. credit card bills, tax liability) | |
| | | |
Investments
(e.g. stocks, shares, bonds, debentures, etc.) | | Others (please specify) | |
| Others (please specify) | | | |
| TOTAL | | | |
| D12. Please provide the personal bank account details from which you will be sending funds to the Government of Saint Lucia |
| Name of account holder | IBAN/BIC CODE |
| Account number | Bank name and address |