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Schedule 5

(Regulation 14)

FORMS

FORM 1

CITIZENSHIP BY INVESTMENT PROGRAMME APPLICATION FOR AUTHORISED AGENT LICENCE

(Please submit application in electronic and printed form).

Please read the following explanatory notes carefully.

I. In accordance with section 31 of the Citizenship by Investment Act, No. 14 of 2015, the Citizenship by Investment Unit (“the Unit”) shall appoint authorised agents who will be licensed to submit applications for Citizenship by Investment on behalf of applicants to the Citizenship by Investment Programme (“CIP”).

II. The Unit shall appoint authorised agents whose professional qualifications, ability, resources, expertise, integrity and/or conduct conform to the guidelines issued by the Unit.

III. The guidelines for authorised agents are attached. Please review them carefully before submitting an application.

IV. Applicants applying as individuals

(a) Need not complete Sections 2, 3 and 8

(b) Must provide original copies of the following document EXCEPT where stated otherwise:

• Two of the IDs detailed in Section 1 (Certified Copies).

• Academic and professional certificates (Certified Copies)

• Curriculum Vitae

• Income Tax Clearance Certificate

• NIC Clearance Certificate

• Statutory Declaration (See Attachment 1A)

V. Applicants applying as a company:

(a) Need not complete Section 3

(b) Must provide:

• Certificate of Incorporation

• Articles of Incorporation

• Notice of Directors (notice of a change of directors or shareholders must be submitted immediately to the Unit)

• Notice of Company's registered office in Saint Lucia

• Articles of Continuation or Bye-Laws (if applicable)

• Income Tax Clearance Certificate

• NIC Clearance Certificate

• Audited financial statement for the period immediately preceding the application

VI. Applicants applying as a partnership:

(a) Need not complete Sections 2 and 8

(b) Must provide:

• Certificate of Registration

• Income Tax Clearance Certificate

• NIC Clearance Certificate

• Audited financial statement for the period immediately preceding the application

1. APPLICANT INFORMATION

1.1 Full Name

Last name

First name

Other name(s)

1.2 Address

Permanent address

City Zip Code

Country

1.3 Contact Details

Home phone

Cell phone

Work phone

Facsimile

Email address

1.4 Identification:

Social Security Number (SSN):

Please provide a copy of the ID for which you have provided the details:

National ID Card Number

Exp. Date (DD-MM-YY)

Passport Number

Exp. Date (DD-MM-YY)

Driver's Licence Number

Exp. Date (DD-MM-YY)

1.5 Are you a resident of Saint Lucia?

Yes

If yes, how long have you been a resident? (YEARS, MONTHS)

If no, which country or countries are you a resident of?

2. COMPANY INFORMATION

2.1 Name of entity

2.2 Company number

2.3 Incorporation date (DD-MM-YY)

2.4 Country of incorporation:

2.5 Registered address

2.6 Type of company (business activity or purpose)

2.7 Business address (if different from 2.5 above)

Address:

City Zip Code

Country

2.8 Business mailing address (if different from 2.7 above)

Address:

City

Zip Code

Country

2.9 Business contact information

Telephone

Facsimile

E-mail address

Website

3. PARTNERSHIP INFORMATION

3.1 Business name

3.2 Registration number

3.3 Country of registration

3.4 Type of partnership (business activity or purpose)

3.5 Business Address

Address:

City

Zip Code

Country

3.6 Business mailing address (if different from 3.5 above)

Address:

City

Zip Code

Country

3.7 Business contact information

Telephone

Facsimile

E-mail address

Website

4. AUTHORISED REPRESENTATIVE

(Please complete for the person who is authorised to accept service of process and any notices required to be served on it on behalf of the applicant)

4.1 Full Name

Last name

Given name(s)

Other name(s)

4.2 Address

Business address

City

Zip Code

Country

4.3 Contact Details

Telephone

Facsimile

Email address

Website

5. AUTHORISED REPRESENTATIVE – ALTERNATIVE

(Please complete for the person who is authorised, in the absence of the person named in 4 above, to accept service of process and any notices required to be served on it on behalf of the applicant)

5.1 Full Name

Last name

Given name (s)

Other name(s)

5.2 Address

Business address

City

Zip Code

Country

5.3 Contact Details

Telephone

Facsimile

Email address

Website

6. ATTORNEY-AT-LAW (If any)

6.1 Full Name

Last name

Given name(s)

Other name(s)

6.2 Address

Business address

City

Zip Code

Country

6.3 Contact Details

Telephone

Facsimile

Email address

Website

7. CHARTERED ACCOUNTANT

7.1 Full Name

Last name

Given name(s)

Other name(s)

7.2 Address

Business address

City

Zip Code

Country

7.3 Contact Details

Telephone

Facsimile

Email address

Website

8. SUBSIDARY COMPANY INFORMATION (if applicable)

(Please provide details of the subsidiary companies of the Authorised Agent where the Authorised Agent is a Company. Attach additional sheets if required)

Name

Address:

Statement of Capital

Company 2

Name

Address:

Statement of Capital

The undersigned hereby affirms that the information contained in this application is true and accurate as of the date shown below and the undersigned is authorised to execute this application.

This day of , .

APPLICANT

Name

SIGNATURE

(Substituted by S.I. 3/2016)

FORM 2

STATUTORY DECLARATION

SAINT LUCIA	IN THE MATTER of Statutory Declarations Act, Cap 2.14
			Form 1 Attachment 1A
I, residing at
in the quarter of do solemnly and sincerely declare as follows:
1. That I am a citizen of .
2. That save the exception of a minor traffic offence, I have never been convicted of an offence under the Laws of Saint Lucia or of any other State.
3. That I am of good character.
4. That I have never been the subject of any refusal of any related application for registration, licence, recognition or authorization by any regulatory authority in any country or jurisdiction.
5. That I have never been the subject of any suspension, cancellation or revocation of registration, licence, recognition or authorization by any regulatory authority in any country or jurisdiction.
6. That no judgement has been rendered against me nor any suit or proceedings are pending against me in any country or jurisdiction which has been based in whole or in part on fraud, theft, deceit, misrepresentation or similar conduct.
7. I have never been charged, indicted or convicted in any country or jurisdiction for any offence in any criminal or civil proceedings relating to fraud or theft arising out of operating or dealing in mutual funds, collective investments schemes/funds, securities, banking or insurance business.
8. I have never been declared bankrupt nor have I been a party to bankruptcy or insolvency proceedings.
9. I have never been a subject of proceedings relating to winding-up, dissolution, creditors' arrangement, creditors' compromise or receivership.
I make this Declaration conscientiously believing the same to be true and in accordance with the Statutory Declaration Act, Cap. 2.14, and I am aware that if there is any statement in this Declaration which is false, or which I know to be false or do not believe to be true, I am liable to imprisonment.
DECLARED before me
this day

Notary		Declarant

(Substituted by S.I. 3/2016)

FORM 3

CITIZENSHIP BY INVESTMENT PROGRAMME APPLICATION FOR AUTHORISED AGENT LICENCE DIRECTOR'S
AND/OR PARTNER'S PROFILE

(Please complete Attachment 1B for each director of partner in your
company. Attach additional copies on separate sheets as required.)

Form 1 Attachment 1B

For each director or partner listed, please provide original copies of the following documents EXCEPT where stated otherwise:

• Two of the photo IDs detailed in 1B5 (Certified Copy)

• Academic and professional certificates (Certified Copy)

• Curriculum Vitae

• A reference letter from a banker

• Income Tax Clearance Certificate

• NIC Clearance Certificate

• Work permit or CARICOM Skills Certificate (if applicable)

• Police certificate valid within the last 6 months

• A certificate of good standing from a professional body to which he or she belongs or a reference letter from an independent professional

1B1. Full Name:

Last name

First name

Other

1B2. Nationality:

1B3. Date of Birth (DD-MM-YY):

1B4. Address:

Permanent

City

Zip Code

Country

1B5. Contact Details:

Home phone

Cell phone

Work phone

Facsimile

Email address

1B6. Identification:

Social Security Number (SSN):

National ID Card Number

Exp. Date (DD-MM-YY)

Passport Number

Exp. Date (DD-MM-YY)

Driver's Licence Number

Exp. Date (DD-MM-YY)

1B7. Occupation:

Employed

Self-Employed

Retired

Unemployed

Profession (if retired give details of past occupation)

Name of Company

Last position held

City

Zip Code

Country

1B8. Is the director/partner a resident of Saint Lucia?

Yes

If yes, how long has he/she been a resident of Saint Lucia? (YEARS MONTHS)

If no, which country or countries is he/she a resident of?

1B9. Has he/she ever been convicted of a felony?

Yes

1B10. Provide evidence of eligibility to work in Saint Lucia?

Yes

(Substituted by S.I. 3/2016)

FORM 4

CITIZENSHIP BY INVESTMENT PROGRAMME APPLICATION FOR AUTHORISED AGENT LICENCE SHAREHOLDER'S PROFILE

(Please complete Attachment 1C for each shareholder in your company.
Attach additional copies on separate sheets as required).

Form 1 Attachment 1C

For each shareholder listed, please provide original copies of the following documents EXCEPT where otherwise stated:

• Two of the photo IDs detailed in 1C4 (Certified Copy)

• Academic and professional certificates (Certified Copy)

• Income Tax Clearance Certificate

• Curriculum Vitae

• Police certificate valid within the last six months

• A reference letter from a banker

• NIC Clearance Certificate

1C1. Full Name:

Last name

First name

Other

1C2. Address:

Permanent

City

Zip Code

Country

1C3. Contact Details:

Home phone

Cell phone

Work phone

Facsimile

Email address

1C4. Identification:

Social Security Number (SSN):

National ID Card Number

Exp. Date (DD-MM-YY)

Passport Number

Exp. Date (DD-MM-YY)

Driver's Licence Number

Exp. Date (DD-MM-YY)

1C5. Number of shares held:

1C6. Other major interests:

Company

Place of Incorporation

Number of shares held

1C7. Is the shareholder a resident of Saint Lucia?

Yes

If yes, how long has he/she been a resident? (YEARS, MONTHS)

If no, which country or countries is he/she a resident of ?

(Substituted by S.I. 3/2016)

FORM 5

APPLICATION FOR PROMOTER LICENCE

CITIZENSHIP BY INVESTMENT PROGRAMME

					1/2

APPLICATION FOR PROMOTER LICENCE
APPLICATION INFORMATION
An individual or company applying for an initial promoter licence after January 31^st in any year, shall pay a prorated fee on the grant of license issued by the Citizenship by Investment Board.
1. TYPE OF LICENSE
Identify whether your application for a Promoter Licence is: (a) an Individual [ ]
(b) a Company [ ]
State name (Individual/Company) to appear on Licence:
2. COMPANY DETAILS & SUPPORTING DOCUMENTS
Company Name:			Company Registration (certified): £
Place of Incorporation:			Trade Licence (certified): £
Number of Shares:			Marketing Plan: £
3. SUPPORTING DOCUMENTS
Provide the following where appropriate for each individual, shareholder or director.
Police Certificate (original): £	National ID
Academic Certificate & CV (original): £	Passport
Passport Bio Data Page (certified): £	Driver's Licence
Other Photo ID: £	Number Exp. Date (DD/MM/YY)
4. PERSONAL & CONTACT DETAILS
Individual £ Shareholder £ Director £⁪

Gender		Date of Birth (mm/dd/yyyy)

Last Name		First Name		Other Name(s)

Nationality (1)		Nationality (2)		Nationality (3)
Current Residential Address:

Telephone (home)		Telephone (mobile)		Email Address
5. ADDITIONAL INFORMATION
*(Individual; Shareholder; Director)*
5(a) Do you have a criminal record? YES £ NO £
If YES, state the offence:
5(b) Have you had a licence revoked by a Citizenship or Residency by Investment Programme? YES £ NO £
5(c) In the case of a company applying for a licence, has it had a licence revoked by any other Citizenship or Residency Programme? YES £ NO £
5(d) Do you have a minimum of 5 years' experience working within the migration/citizenship sector? YES £ NO £
6. AUTHORISED AGENT
The following Authorized Agent has been selected to submit citizenship applications on my behalf to the Citizenship by Investment Unit of Saint Lucia.
Name:
Licence Number:
7. DATE & SIGNATURE
I certify that I have read and understood all the questions in this form and that the information provided, whether supplied directly by myself or third party completing the form on my behalf, is true and up to date in every detail.
I herewith 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 any agent(s) that the Unit may choose to engage, to decide to obtain further information, criminal records or any kind of records about me and or my company, which the Unit may deem necessary. I understand that such information, records and reports 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 partner(s) 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 company given on this form or otherwise obtained by the Unit in order to verify such information or obtain such reports or records about me and/or my company, which may assist the Unit in deciding whether I and/or my partner(s) qualify for a Promoter Licence of Saint Lucia.
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 Citizenship by Investment Unit, for the interim period between the date of this application and the date of granting licence.
I herewith apply to be approved as a licensed Promoter of the Citizenship by Investment Programme of Saint Lucia.

Date			Signature

(Substituted by S.I. 3/2016 and by S.I. 162/2023)

FORM 6

CITIZENSHIP BY INVESTMENT IN SAINT LUCIA

APPLICATION FOR RENEWAL OF LICENCE AUTHORISED AGENT

(Citizenship by Investment Act: Section 31)

(TO BE COMPLETED IN DUPLICATE)

1. Name of licensee:
£ Authorised agent Licence number:
2. Address, telephone and facsimile number in Saint Lucia of the principal place of business of the licensee and, in the case of a company, its registered office:
Address:



Telephone: Facsimile:
3. State, or attach a description of, any material changes from the information provided on the licensee's application for authorised agent licence, or last application for authorised agent licence:





The undersigned affirms that the information contained in this application for renewal is true and accurate as of the date shown below and the undersigned is authorised to execute this application for renewal on behalf of the licensee.
4. FEES: US$
Annual licence fee:
Total fees enclosed:
This day of
	LICENSEE
	Name:
	Signature:

FORM 7

CITIZENSHIP BY INVESTMENT IN SAINT LUCIA AUTHORISED AGENT

(Citizenship by Investment Act: Section 31)

I hereby certify that
(Name of licensee)
has this day
(Date of grant of licence)
been registered and duly licensed as a
Authorised Agent
under the Citizenship by Investment Act, No. 14 of 2015 in the State of Saint Lucia.

	Authorised Signature

(Substituted by S.I. 3/2016)

FORM 8

CITIZENSHIP BY INVESTMENT IN SAINT LUCIA PROMOTER

(Citizenship by Investment Act: Section 31)

I hereby certify that
(Name of licensee)
has this day
(Date of grant of licence)
been registered and duly licensed as a
Promoter
under the Citizenship by Investment Act, No. 14 of 2015 in the State of Saint Lucia.

	Authorised Signature

(Substituted by S.I. 3/2016)

FORM 9

CITIZENSHIP BY INVESTMENT IN SAINT LUCIA

MARKETING AGENT
I hereby certify that
(Name of licensee)
has this day
(Date of grant of licence)
been registered and duly licensed as a
Marketing Agent
under the Citizenship by Investment Act, No in the State of Saint Lucia.

	Authorised Signature

(Substituted by S.I. 3/2016)

FORM 10

CERTIFICATE OF REGISTRATION

(Citizenship by Investment Act:
Sections 30(1) and (2), 36 and 37)
No.
INSERT NAME has applied to the Citizenship by Investment Unit to be registered as a citizen of Saint Lucia under section 30(1) or 30(2) of the Citizenship by Investment Act, alleging the particulars set out below:
INSERT NAME has satisfied *the Board/the Minister with respect to the requirements laid down in the Citizenship by Investment Act for registration as a citizen;
This is to certify that *the Board grants the application under section 36 of the Citizenship by Investment Act/the Minister grants the request for a review and approves the application for citizenship by investment under section 37 of the Citizenship by Investment Act and that INSERT NAME is a citizen of Saint Lucia from the date of this Certificate.
	PARTICULARS OF APPLICANT
	PHOTOGRAPH
	Full name:
	Address:
	Profession or occupation:
	Place and date of birth:
	Marital status:
In witness whereof, I have hereunto subscribed my name this ............ day of .............................. 20[ ].

		Minister to whom the Citizenship by Investment Programme is assigned.
* Delete as appropriate

(Inserted by S.I. 11/2018 and substituted by S.I. 48/2019)

FORM 11

OATH OR AFFIRMATION OF ALLEGIANCE

(Citizenship by Investment Act: Section 36(5))

I, affirm//

swear by Almighty God that I will be faithful and bear true allegiance to Her Majesty Queen Elizabeth the Second, Her Heirs and Successors, according to law.

Signed

Sworn/affirmed this ............... day of ...................................... 20...........

At:

Before me

Consular Officer of Saint Lucia/Honorary Consul of Saint Lucia/Notary Royal/Notary Public/Attorney-at-Law.

(Inserted by S.I. 48/2019)

CITIZENSHIP BY INVESTMENT PROGRAMME DOCUMENT CHECKLIST

							SL 1

PLEASE COMPLETE THE FOLLOWING AND INCLUDE THE COMPLETED CHECKLIST IN YOUR SUBMISSION

First Name			Last Name

Date of Birth			Passport Number
Please note that the information below provides guidance on the required submission of documentation from a —
Principal Applicant Spouse Dependant 16 and Over Dependant under 16 years
	Required Format	Principal Applicant		Spouse	Qualifying Dependant 16 and Over	Qualifying Dependant Under 16
1. Proof of payment of non-refundable processing and due diligence fees.	Original			NA	NA	NA
2. SL1 – Document Checklist	Original
3. SL2A – PRINCIPAL APPLICANT – Application to Become a Citizen of Saint Lucia	Original			NA	NA	NA
4. SL2B – SPOUSE / DEPENDANT – Application to Become a Citizen of Saint Lucia	Original	NA
5. SL3 – Photograph and Signature Form	Original
For children who are below the age of 18 or where a qualifying dependant is physically or mentally challenged and cannot write, please insert N/A in the field 'Specimen Signature'
	Required Format	Principal Applicant		Spouse	Qualifying Dependant 16 and Over	Qualifying Dependant Under 16
6. SL4 – Investment Confirmation Form				NA	NA	NA
7. Affidavit in Support with an indication of the following information with respect to the principal applicant —	Original			NA	NA	NA
• Personal details
• Employment details
• Annual income and approximate net worth
• The name of the qualifying dependants
• Source of wealth
• Ability to make payments of all required fees for the principal applicant and the dependant
The Affidavit in support must be sworn before a Notary Royal or an attorney-at law and be accompanied by an Apostille from the country where the Affidavit in Support is prepared.
8. Excerpt of Birth Record or Birth Certificate	Certified Copy
This is a birth document that also includes your parents' details, or a household register, family book, etc.
	Required Format	Principal Applicant		Spouse	Qualifying Dependant 16 and Over	Qualifying Dependant Under 16
9. Passport Pages	Certified Copy
All pages of your current passport(s)
10. Two (2) passport-sized photos of yourself taken within the last 6 months. The photos MUST be —	Original
• A full front close-up view of the head and shoulders with the head covering 70% to 80% of the photograph, ears showing and hairline visible above the forehead.
• Taken without sunglasses. Tinted prescription glasses may be worn if eyes are still visible showing you looking straight at the camera, your eyes open, no hair in your eyes and without hair covering except that of religious head covering.
• Taken against a plain a white background without shadows.
	Required Format	Principal Applicant		Spouse	Qualifying Dependant 16 and Over	Qualifying Dependant Under 16
• Be taken with a neutral expression (no laughing or frowning) with your mouth closed.
• A true image which has not been altered in any way.
• Approximately 5 cm x 5 cm in size, of good quality color and on high quality paper.
• The six photos MUST be the same in all aspects with two of the photos certified to be a true likeness of the bearer.
• One of the non -certified photos must be affixed to the photograph and Signature Certificate.
11. Police Certificate(s)	Original					NA
Submit a Police Certificate from your country of birth, and from any other country in which you have resided for at least one year during the ten (10) years immediately preceding the submission of your applications for citizenship of Saint Lucia. The police certificate should be no more than 6 months old.
	Required Format	Principal Applicant		Spouse	Qualifying Dependant 16 and Over	Qualifying Dependant Under 16
If you are unable to obtain a police certificate, please provide an explanation.
Police certificates are not required for qualifying dependants below the age of sixteen (16) years.
12. Proof of residential address.	Original			NA	NA	NA
One document of proof of your residential address valid at least 3 months immediately preceding the submission of the application.
Examples of proof of residential address include recent utility bill or bank statement showing full name and address.
13. Curriculum Vitae	Original					NA
Required for all applicants eighteen (18) years and over. Be sure to cover the last ten (10) years preceding the application. Do not leave any gaps.
14. Bank Reference Letter	Original			NA	NA	NA
Issued by an internationally recognized bank valid within the last 6 months immediately preceding the submission of the application.
15. Professional and Academic Certificates	Certified Copy
Required for each applicant 18 years and above.
16. Credentials for Attorney-at-Law or Notary Royal	Certified Copy			NA	NA	NA
Required for each Attorney-at-Law and Notary Royal used to certify documents submitted as part of the application.
THE FOLLOWING DOCUMENTS ARE TO BE INCLUDED IN YOUR SUBMISSION, IF APPLICABLE TO YOU
17. Proof of Name Change (if applicable)	Certified Copy
ONLY applicants who have had a name change are required to provide this supporting document.
18. Certificate of Citizenship	Certified Copy
19. Permanent Resident Card or Certificate	Certified Copy
20. National Identification Card	Certified Copy
21. Copies of your current and expired visas	Certified Copy
22. Marriage Record(s) or Marriage Certificate(s)	Certified Copy			NA	NA	NA
23. Divorce Decree	Certified Copy			NA	NA	NA
24. Custody or Guardianship Records	Certified Copy				NA	NA
25. Statutory Declaration of Non-Accompanying Parent	Original			NA	NA	NA
Required for qualifying dependants below the age of eighteen (18) years, indicating that the parent has no objection to his or her child acquiring Saint Lucian citizenship.
26. Photo Identification of Non-Accompanying Parent	Certified Copy			NA	NA	NA
MUST bear the signature of the non-accompanying parent.
27. Military records	Certified Copy					NA
You must submit if you have served in the military or armed forces for any period.
28. Official transcripts or written confirmation of Registration from a recognized School, University or College.	Certified Copy	NA		NA		NA
Required for any dependant between the ages of 18 and 25 years who is enrolled in school, university, or college at the time of submitting the application.
29. Credentials for Translator	Certified Copy			NA	NA	NA
Required for each translator used to translate documents submitted as part of the application.

(Inserted by S.I. 3/2016 and substituted by S.I. 162/2023)

CITIZENSHIP BY INVESTMENT PROGRAMME
USE OF AUTHORISED AGENT FORM

					SL 2

General Information:
Authorised agents are parties who have provided advice and guidance to you prior to the submission of your application, and are the only persons who may submit an application and subsequently act on your behalf with the Citizenship by Investment Unit of Saint Lucia.
The authorised agent must maintain a place of business in Saint Lucia and must be licensed. Your authorised agent will be able to provide you with the information requested on this form (such as license number).
You may choose to work with ANY licensed authorised agent. Please note that ONLY the Citizenship by Investment Board can approve your application for Saint Lucian citizenship. No other person, agent, agency or organization can guarantee the approval of your application.
Section A: Your Personal Details
A1. Surname or Family Name (as shown on birth certificate)			A2. First or Given Name(s) (as shown on birth certificate)
A3. Place of birth	A4. Country of Birth		A5. Date of birth DD/MM/YYYY	A6. Gender
A7. Current residential address			A8. Passport details – Issuing country and passport number
• I authorize the following individual or entity to serve as my authorised 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 dependant children to my authorised 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, Cap. 8.18, will likely not be released.
Place and date		Signature of principal applicant
Section B: Authorised agent Details This section MUST be completed by the authorised agent.
Name of authorised agent.		Authorised agent licence number.
Address in full.		Business telephone number
Mobile telephone number		Email address
Promoter who referred applicant (please write N/A if you did not get a referral)		Promoter licence number.

Place and Date		Signature of Authorised agent

(Inserted by S.I. 3/2016)

APPLICATION FOR SAINT LUCIAN CITIZENSHIP - PRINCIPAL APPLICANT

SL 2A

CITIZENSHIP BY INVESTMENT PROGRAMME

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.

1. APPLICANT DETAILS

1.1 Your full name as shown on your birth certificate.

Family Name or Surname

First Name

Middle Name

Other Name(s)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY

Gender

1.2 Permanent Address

Street Address

City

Zip Code

Country

1.3 Passport Details

Issuing Country

Passport Number

1.4 Contact Information

Mobile Telephone Number

Home Telephone Number

Email Address

LinkedIn Profile

1.5 Contact information for a person other than the applicant:

Name

Relation to the applicant

Email Address

Physical address

Telephone

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.

Name of Authorized Agent

Authorized Agent Licence Number

Authorized Agent Address in Full

Business Telephone Number

Mobile Telephone Number

Email Address

Promoter who Referred Applicant

Promoter Licence Number

*Please write N/A if you did not get a referral From a Promoter.

Marketing Agent who Referred Applicant

Marketing Agent Licence Number

*Please write N/A if you did not get a referral From a Marketing Agent

Place

Date

Signature of Authorized Agent

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

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.

Family Name (Last Name)

First Name

Middle Name

Other Name(s)

4.2 Please write your name as it is written in Ethnic Script in the space below.

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

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

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

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.

5.4 What are your social security details?

Social Security Number

Issuing Country

5.5 National Identification Card Details (Attach a certified copy of your National Identification Card, if applicable)

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

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)

Street Address

City

Zip Code

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

Country/Territory

Prov/State

Postal Code

District

PRESENT

From (DD/MM/YYYY)

Apt/Unit

Street No.

Street Name

City/Town

To (DD/MM/YYYY

Country/Territory

Prov/State

Postal Code

District

From (DD/MM/YYYY)

Apt/Unit

Street No.

Street Name

City/Town

To (DD/MM/YYYY

Country/Territory

Prov/State

Postal Code

District

From (DD/MM/YYYY)

Apt/Unit

Street No.

Street Name

City/Town

To (DD/MM/YYYY

Country/Territory

Prov/State

Postal Code

District

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

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.

Date of Marriage

Place of Marriage (City/Town/Country or Territory

If divorced, please attach a certified copy of your Divorce Decree.

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:

Spouse's Full Name (after marriage)

Spouse's Full Name (before marriage)

Last Name (Surname)

First Name

Middle Name

Other Name(s)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY)

Gender

Spouse's Occupation

Spouse's Email Address

Spouse's Nationality

Spouse's Passport Number

6.3 Spouse's Residential Address, if different from your residential address.

Street Address

City

Zip Code

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:

Father's Last Name (Surname)

Father's First Name (Given Name)

Father's Middle Name(s)

Father's Other Name(s) (Known As)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY

Father's Occupation

Father's Email Address

Father's Nationality

Father's Passport Number

6.5 Father's Residential Address, if different from your residential address.

Street Address

City

Zip Code

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:

Mother's Last Name (Surname)

Mother's First Name (Given Name)

Mother's Middle Name(s)

Mother's Other Name(s) (Known As)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY

Mother's Occupation

Mother's Email Address

Mother's Nationality

Mother's Passport Number

6.7 Mother's Residential Address, if different from your residential address.

Street Address

City

Zip Code

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:

Child's Last Name (Surname)

Child's First Name (Given Name)

Child's Middle Name(s)

Child's Other Name(s) (Known As)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY)

Child's Occupation

Child's Email Address

Child's Nationality

Child's Passport Number

6.9 Child's Residential Address, if different from your residential address.

Street Address

City

Zip Code

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:

Sibling's Last Name (Surname)

Sibling's First Name (Given Name)

Sibling's Middle Name(s)

Siblings' Other Name(s) (Known As)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY)

Sibling's Occupation

Sibling's Email Address

Sibling's Nationality

Sibling's Passport Number

6.11 Sibling's Residential Address, if different from your residential address.

Street Address

City

Zip Code

Country

Date since residing at address (DD/MM/YYYY)

6.12 Previous Spouse Personal Details, if applicable. (Attach additional pages if necessary)

Previous Spouse's Full Name
(after marriage)

Previous Spouse's Full Name
(before marriage)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY)

Gender

Date of Divorce Order/Decree

Duration of Marriage
(number of months/years)

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.

Name of Business

Nature of Business

Registered Address of Business

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)

Name of Employer

Nature of Employer's Business

Registered Address of Employer's Business

Employer's Website Address

Employer's Telephone Number

Employer's LinkedIn

7.3 What is your main source(s) of income?

7.4 What is the main geographical jurisdiction(s) in which you work/conduct business?

7.5 What are the most frequent companies or persons with whom you do business?

7.6 List all the companies of which you are currently a director or shareholder.

7.7 What is your estimated gross annual income in USD?

7.8 Please provide the personal bank account details from which you will be sending funds to the Citizenship by Investment Board.

Name of Account Holder

IBAN/BIC Code

Account Number

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.

Name of Account Holder

IBAN/BIC Code

Account Number

Bank Name and Address

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

9. DECLARATIONS

Yes

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.

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.

Place

Date

Signature of Applicant

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.

(Inserted by S.I. 3/2016 and substituted by S.I. 162/2023)

APPLICATION TO BECOME A CITIZEN OF SAINT LUCIA – DEPENDANT

SL 2B

CITIZENSHIP BY INVESTMENT PROGRAMME

I am completing this form as a:

Spouse of a Principal Applicant Dependant of a Principal Applicant

1. APPLICANT DETAILS

1.1 Your full name as shown on your birth certificate.

Family Name (Surname)

First Name

Middle Name

Other Name(s)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY)

Gender

1.2 Permanent Address

Street Address

City

Zip Code

Country

1.3 Passport Details

Issuing Country

Passport Number

1.4 Contact Information

Mobile Telephone Number

Home Telephone Number

Email Address

LinkedIn Profile

2. PERSONAL DETAILS

2.1 Have you changed your name since birth? …Yes No

If yes, state the method used to change your name

Marriage Deed Poll Adoption Other

(Insert your new legal name below. You must submit one supporting document as proof of name change e.g. Deed Poll; Adoption Papers etc.)

Family Name (Last Name)

First Name

Middle Name

Other Name(s)

Please note that should citizenship be granted, a name change will not be permitted within five (5) years.

2.2 Please write your name as it is written in Ethnic Script in the space below.

2.3 Do you hold, or have you ever held any other citizenship? …Yes No

Country or Territory of Citizenship

Date of Citizenship

Explanation

2.4 Do you hold, or have you ever held permanent residency in any country? ___ Yes ___ No

Country or Territory of Citizenship

Date of Permanent Residency

Explanation

2.5 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

3. 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.

3.1 Natural eye color Blue Grey Brown Green Black Other

3.2 Height cm or ft. in.

3.3 Identify any distinguishing marks:

Describe below.

3.4 Social security details?

Social Security Number

Issuing Country

3.5 National Identification Card Details (Attach a certified copy of your National Identification Card, if applicable)

Identification Card Number

Issuing Country

Expiry Date

3.6 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

3.7 Current Address (Please provide proof of your current residential address. Proof of residence may include a utility bill, lease agreement, bank statement with relevant address)

Street Address

City

Zip Code

Country

3.8 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

PRESENT

Country/Territory

Prov/State

Postal Code

District

From (DD/MM/YYYY)

Apt/Unit

Street No.

Street Name

City/Town

To (DD/MM/YYYY

Country/Territory

Prov/State

Postal Code

District

From (DD/MM/YYYY)

Apt/Unit

Street No.

Street Name

City/Town

To (DD/MM/YYYY

Country/Territory

Prov/State

Postal Code

District

From (DD/MM/YYYY)

Apt/Unit

Street No.

Street Name

City/Town

To (DD/MM/YYYY

Country/Territory

Prov/State

Postal Code

District

3.9 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

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

4. FAMILY INFORMATION

4.1 Marital status:

Never Married Married Divorced Separated Widowed

If married, please attach a certified copy of your Marriage Certificate.

Date of Marriage

Place of Marriage (City/Town/Country or Territory

If divorced, please attach a certified copy of your Divorce Decree.

Date of Divorce

Place of Divorce (City/Town/Country or Territory

4.2 Spouse Personal Details, if applicable.

Spouse's Full Name (after marriage)

Spouse's Full Name (before marriage)

Last Name (Surname)

First Name

Middle Name

Other Name(s)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY)

Gender

Spouse's Occupation

Spouse's Email Address

Spouse's Nationality

Spouse's Passport Number

4.3 Spouse's Residential Address, if different from your residential address.

Street Address

City

Zip Code

Country

Date since residing at address (DD/MM/YYYY

4.4 Father's Personal Details.

Father's Last Name (Surname)

Father's First Name (Given Name)

Father's Middle Name(s)

Father's Other Name(s) (Known As)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY)

Father's Occupation

Father's Email Address

Father's Nationality

Father's Passport Number

4.5 Father's Residential Address, if different from your residential address.

Street Address

City

Zip Code

Country

Date since residing at address (DD/MM/YYYY)

4.6 Mother's Personal Details.

Mother's Last Name (Surname)

Mother's First Name (Given Name)

Mother's Middle Name(s)

Mother's Other Name(s) (Known As)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY)

Mother's Occupation

Mother's Email Address

Mother's Nationality

Mother's Passport Number

4.7 Mother's Residential Address, if different from your residential address.

Street Address

City

Zip Code

Country

Date since residing at address (DD/MM/YYYY)

4.8 Children's Personal Details. (Complete for all biological, adopted and stepchildren. Attach additional pages as required)

Child's Last Name (Surname)

Child's First Name (Given Name)

Child's Middle Name(s)

Child's Other Name(s) (Known As)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY)

Child's Occupation

Child's Email Address

Child's Nationality

Child's Passport Number

4.9 Child's Residential Address, if different from your residential address.

Street Address

City

Zip Code

Country

Date since residing at address (DD/MM/YYYY)

4.10 Sibling's Personal Details. (Complete for all siblings including half, step, and adopted. Attach additional pages as required)

Sibling's Last Name (Surname)

Sibling's First Name (Given Name)

Sibling's Middle Name(s)

Siblings' Other Name(s) (Known As)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY)

Sibling's Occupation

Sibling's Email Address

Sibling's Nationality

Sibling's Passport Number

4.11 Sibling's Residential Address, if different from your residential address.

Street Address

City

Zip Code

Country

Date since residing at address (DD/MM/YYYY)

4.12 Previous Spouse Personal Details, if applicable. (Attach additional pages if necessary)

Previous Spouse's Full Name (after marriage)

Previous Spouse's Full Name (before marriage)

Place of Birth

Country of Birth

Date of Birth (DD/MM/YYYY)

Gender

Date of Divorce Order/Decree

Duration of Marriage (number of months/years)

5. EDUCATION & PROFESSIONAL CERTIFICATION

Start MM/YY

End MM/YY

Name of Institution

Address of Institution

Qualification Achieved

6. DECLARATIONS

Yes

6.1

Excepting a minor offence, have you ever been:

[ ] arrested

[ ] detained

[ ] charged

[ ] indicted

[ ] convicted

[ ] found guilty

[ ] had a criminal record expunged?

6.2

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?

If yes, note date, city, state, and country in which the court declared you bankrupt.

6.3

Have you ever had a visa cancelled?

6.4

Have you ever been declared bankrupt by a court?

If yes, note date, city, state, and country in which the court declared you bankrupt.

6.5

Have you ever been involved personally, or as a director, in any bankruptcy, insolvency or liquidation proceedings?

6.6

Have you ever testified before a grand jury or investigative hearing or probe?

6.7

Have any charges, or accusations of illegal activity of any nature been made against you in any country?

6.8

Have you ever been the subject of a criminal investigation?

6.9

Have you ever been considered a potential national security risk in any country?

6.10

Have you ever been sentenced to serve a period in detention or been on probation?

6.11

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?

6.12

Have you ever had a civil or criminal record expunged or sealed by a court order?

6.13

Have you ever been subpoenaed to appear to testify before a federal, state or county grand jury, board, or commission?

6.14

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?

6.15

6.16

Have you ever been involved, directly or indirectly, in the financing of terrorism or in any terrorist or criminal organization?

6.17

Have you ever been unlawfully present in or been deported from any country, or sought to assist others to do the same?

6.18

Have you ever applied for citizenship in any country for which the citizenship has NOT been granted?

6.19

6.20

Are you a politically exposed person (PEP)?

6.21

Have you ever been declared by a court or a qualified health practitioner to be mentally incapacitated?

6.22

Are there any other business activities in which you are engaged that have not already been disclosed on this form?

6.23

To the best of your knowledge, have you ever been under investigation by any law enforcement agency or tax authority in any country?

6.24

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 kind?

6.25

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 6.24 or 6.25 please provide with further details. Clearly indicate that number for which the details are being provided in each case. Attach additional sheets as required.

7. DATE AND SIGNATURE

I herewith authorize, without reservation, the Citizenship by Investment Unit (“the Unit”) to verify any personal information about me and/or my dependants, where an application has been lodged 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 decide to obtain further information, credit reports, criminal records, or any kind of records 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.

I understand that becoming a citizen of Saint Lucia may affect my current citizenship status.

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.

Place

Date

Signature of Applicant

8. DECLARATION

Place

Date

Signature of Applicant

(Inserted by S.I. 162/2023)

CITIZENSHIP BY INVESTMENT PROGRAMME
STATEMENT OF ALTERNATIVE CITIZENSHIP

		SL 3
Please provide a detailed explanation of the reason(s) you are seeking to obtain an alternative citizenship and the reason(s) why you have opted for Saint Lucian citizenship in particular.


Place and date	Signature of principal applicant

(Inserted by S.I. 3/2016)

INVESTMENT CONFIRMATION FORM

SL 4

CITIZENSHIP BY INVESTMENT PROGRAMME

This investment confirmation form is to be completed in English by the principal applicant ONLY.
CITIZENSHIP BY INVESTMENT CRITERIA		Please complete only ONE of sections 1-4, according to the type of investment you are making and whether you are applying with a spouse or other qualifying dependant(s)
A qualifying investment under the Citizenship by Investment Programme shall satisfy at least a minimum investment in:
Investment Options	Minimum Qualifying
	Investment
	USD
Investment by the purchase of National Action Government Bond	$300,000
The Saint Lucia National Economic	$100,000
Fund 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	$500,000

1. PRINCIPAL APPLICANT DETAILS
1.1 Full Name

Surname of Family Name (as shown on birth certificate )		First or Given Name(s) (as shown on birth certificate)

Place of Birth	Country of Birth	Date of Birth (DD/MM/YYYY)	Gender
1.2 Current Residential Address

		City	Zip Code

Street Address		Country
1.3 Passport Details

Issuing Country	Passport Number
2. PLEASE LIST THE DETAILS OF YOUR SPOUSE/DEPENDANTS TO BE INCLUDED IN THIS APPLICATION

Last Name (Surname)	First Name (Given Name)	Date of Birth (DD/MM/YYYY)	Relationship to Principal Applicant

Last Name (Surname)	First Name (Given Name)	Date of Birth (DD/MM/YYYY)	Relationship to Principal Applicant

Last Name (Surname)	First Name (Given Name)	Date of Birth (DD/MM/YYYY)	Relationship to Principal Applicant

Last Name (Surname)	First Name (Given Name)	Date of Birth (DD/MM/YYYY)	Relationship to Principal Applicant
3. PLEASE SELECT ONE OF THE INVESTMENT OPTIONS IN SUPPORT OF YOUR APPLICATION FOR CITIZENSHIP BY INVESTMENT, SAINT LUCIA
£ 3.1 I CHOOSE TO INVEST IN THE PURCHASE OF NATIONAL ACTION BOND (MINIMUM INVESTMENT OF $300,000)
Details		Minimum Investment Amount USD	Administrative Fees USD
Applicant applying with any number of dependants		$300,000	$50,000
TOTAL INVESTMENT AMOUNT

£ 3.2 I CHOOSE TO INVEST IN THE SAINT LUCIA NATIONAL ECONOMIC FUND (MINIMUM INVESTMENT OF US $100,000)
Details			Minimum Investment Amount USD
Applicant applying alone			$100,000
Applicant applying with spouse ONLY			$140,000
Applicant applying with spouse and up to two (2) other qualifying dependants			$150,000
Each additional qualifying dependant of any age			$25,000 EACH
Each qualifying dependant in addition to a family of four (family includes a spouse)			$15,000 EACH
ADD-ON OF QUALIFYING DEPENDANTS OF A CITIZEN
Newborn child of a citizen who is 12 months of age & below			$500
Spouse of a citizen			$35,000
Qualifying dependant of a citizen other than a spouse			$25,000
TOTAL INVESTMENT AMOUNT
£ 3.3 I CHOOSE TO INVEST IN AN APPROVED REAL ESTATE PROJECT. (MINIMUM INVESTMENT OF US $200,000)
Details		Minimum Investment Amount USD	Administrative Fees USD
Applicant applying alone		$200,000	$30,000
Applicant applying with spouse alone		-	$45,000
Each qualifying dependant below 18		-	$5,000 EACH
Each qualifying dependant 18 and over		-	$10,000 EACH
Applicant applying with spouse an over 4 qualifying dependants		-	$10,000 EACH
TOTAL INVESTMENT AMOUNT

Real Estate Project (as per the name listed by the Citizenship by Investment Unit
Name and Number
Purchase Price USD
£ 3.4 I CHOOSE TO INVEST IN AN APPROVED ENTERPRISE PROJECT. (MINIMUM INVESTMENT OF US $100,000)
Details		Minimum Investment Amount USD	Administrative Fees USD
Option 1: Applicant applying alone		$3,500,000	$50,000
Option 2: Applicant applying as a joint venture		$6,000,000 (each applicant MUST invest a minimum of $1,000,000)	$50,000 EACH
Each qualifying dependant below 18		-	$25,000 EACH
Each qualifying dependant above 18		-	$35,000 EACH
Option 3:
Applicant Alone		$100,000	$15,000
Applicant and any number of qualifying dependants		$150,000
Applicant applying with two dependants			$20,000 EACH
Applicant applying with three dependants			$25,000 EACH
Applicant with three qualifying dependants or more			$30,000 EACH


TOTAL INVESTMENT AMOUNT

Enterprise Project (as per the name listed by the Citizenship by Investment Unit)

Name and Number
Purchase Price USD
In the case of a joint venture, list the names of all the business partners
£ 3.5 I CHOOSE TO INVEST IN THE PURCHASE OF GOVERNMENT BONDS (MINIMUM INVESTMENT OF $500,000)
Details		Minimum Investment Amount USD	Administrative Fees USD
Applicant applying alone		$500,000
Applicant applying with spouse ONLY		$535,000
Applicant applying with spouse and up to two (2) other qualifying dependants		$550,000
Each additional qualifying dependant of any age		$25,000 EACH
TOTAL INVESTMENT AMOUNT

3.6 INVESTMENT DECLARATION
I, the undersigned, , hereby confirm
that I will invest the amount declared above, to be considered my investment which makes me eligible for Citizenship by Investment in Saint Lucia under the Citizenship by Investment Act.

Place	Date	Signature of Principal Applicant

(Inserted by S.I. 3/2016 and substituted by S.I. 162/2023)

CITIZENSHIP BY INVESTMENT PROGRAMME
PHOTOGRAPH AND SIGNATURE CERTIFICATE

				SL 6
This Photograph and Signature Certificate is to be completed in English by a Notary Public, an Attorney-at-Law or by two Senior Officer(s) of an internationally recognized bank, who must ask for evidence of identification (such as a passport or National ID card) The person completing the certificate MUST certify the photograph to be a true likeness and the signature to be the true signature of the person whose details appear on this form.
One form for each applicant and qualifying dependant (including children) is to be completed. For children who are below the age of 18 years or where a qualifying dependant is physically or mentally challenged and cannot write, please insert “N/A” in the field “Specimen Signature.”
The certification should be made by signature and stamp or seal in Section B or on the reverse side of this form in which case the following should be stated in Section B. “See certification on reverse side.”
Please attach one photograph of yourself taken within the past 6 months in the box below. The photograph should be approximately 35 x 45mm in size and must be attached to this Certificate in a way that it cannot be removed without tearing the photograph or form.
Please ensure that the photograph complies with the requirements as specified on the Document Checklist SL1
A. Personal Details
Surname or family name as shown in passport	First or given name(s) as shown in passport
Place and country of birth	Date of birth		Gender
ID or passport details (issuing country and ID/passport number)	Specimen signature
B. Certification
I/we certify that I/We have confirmed the identity of the person whose details appear on this form, who has presented sufficient evidence of identification.
I/we certify that the photograph attached on this form is a true likeness of the person whose details appear on this form.
I/we certify that the specimen signature above has been given in my/our presence by the person whose details appear on this form

Signature		Date

Signature		Date

(Inserted by S.I. 3/2016)

SL 7

(Inserted by S.I. 3/2016 and deleted by S.I. 162/2023)

				SL 8
	On behalf of the Applicant
	Deponent:[Insert name of Applicant]
	Date Sworn:[e.g. 5th November, 2020]
	IN THE MATTER of an Application for Citizenship by Investment in Saint Lucia under section 30(6) of the Citizenship by Investment Act, No. 14 of 2015

AFFIDAVIT OF SUPPORT

I [insert name], of [insert full address] being duly sworn ON OATH, depose and say as follows:-
1. That I am the Principal Applicant for Citizenship by Investment in Saint Lucia.
2. That I have sufficient income and assets to financially support all of my qualifying dependants who have also made an application for Saint Lucian citizenship.
3. My qualifying dependants to my application are listed as follows:
State names and relationships to the Principal Applicant
4. That I will pay all of the costs associated to this application for my dependants.
5. That the facts stated above are true and correct to the best of my knowledge and belief.
SWORN to at [STATE AND COUNTRY]		}
this [DATE] day of [MONTH], [YEAR].
		}	[SIGNATURE]
Before me: [INSERT NAME]		}
[PRINCIPAL APPLICANT NAME]
		}	Deponent
		}
[TITLE: (NOTARY OR COMMISSIONER OF OATHS]
[INSERT ADDRESS]

(Inserted by S.I. 3/2016)

CITIZENSHIP BY INVESTMENT PROGRAMME
MEDICAL EXAMINER DETAILS AND DECLARATION

SL 9

SECTION A: APPLICANT'S DETAILS

Surname or Family Name (as shown on Birth Certificate)

First or Given Name(s) (as shown on Birth Certificate)

Place of birth

Country of Birth

Date of birth DD/MM/YYYY

Gender

Current residential address

Passport details – Issuing country
and passport number

SECTION B: MEDICAL EXAMINER'S DETAILS

Attach a certified copy of the professional certificate(s) of the medical examiner to this form.

Full name of medical examiner:

Organisation

Position

Organisation's address

Telephone number

Fax number

Date of Examination

Place of Examination

Examiner's designation/ qualification

Examiner's license number or certificate

SECTION C: MEDICAL EXAMINATION

The medical examiner is required to examine the applicant and answer the following questions. If any of the questions below is answered with a yes, please provide details either in the space provided at the end of this form or on an attached sheet.

Applicant's weight

Applicant's height

C1. Are there any signs of:

Yes

Skin disease?

Abnormalities of the respiratory system,
including nose and lungs?

Abnormalities of the cardiovascular system,
including pulse, blood pressure, heart murmurs?

Abnormalities of the digestive organs and abdomen?

Abnormalities of the urogenital organs?

Abnormalities of the nervous system and sense organs?

Abnormalities of the musculoskeletal system?

Abnormalities of the endocrine system?

Contagious disease?

10.

Any other abnormalities?

C2. Have you had, or do you presently have, any of the following conditions:

Yes

Tubercolosis?

Hepatitis (A, B, or C)?

Typhoid?

Any other communicable disease?

Any other heart condition (including congenital defects)?

Stroke?

Yes

Any immune deficiency disease?

Cancer?

AIDS / HIV?

10.

Are you currently taking any prescribed medicine?

11.

Do you currently have any other serious health problems? (other than listed above)

Yes

12.

Have you been hospitalized in the last 5 years?

13.

Have you visited a doctor in the last 3 years for anything other than a routine check-up?

14.

For female applicants – Are you pregnant?
If yes, what is the expected date of birth?

15.

Are you dependant on alcohol or drugs
(including narcotics)?

16.

Is there any further information which may be medically relevant?

Provide details below

I hereby confirm that I have identified, questioned and examined the applicant and have answered all questions to the best of my knowledge and in good faith.

Stamp of medical examiner (if applicable)

Signature of medical examiner

(Inserted by S.I. 3/2016)

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Schedule 5

1. Short Title

2. Interpretation

3. Act binds the Crown

4. Establishment of Board

5. Constitution of Board

6. Disqualification

7. Functions of Board