FORM 3 |
(Regulation 4(1)) |
THE CITIZENSHIP OF SAINT LUCIA ACT |
Application for Registration as a Citizen of Saint Lucia under section 6(1) or 6(2) of the Act |
Note: | Applicants are requested to submit— |
| (a) three (3) completed copies of this Form; (b) three (3) identical passport size photographs; (c) a police certificate of character; (d) proof of satisfactory fulfilment of income tax obligations; (e) two (2) references. |
1. | Full name |
2. | Name at birth, if different from above |
3. | Country, place and date of birth | Country Place Date |
4. | (a) National Insurance no. |
| (b) Saint Lucia Identification Card no. |
5. | (a) Nationality at birth |
| Present Nationality, if different |
| (b) State how change in nationality |
| was made (if stateless, say how |
| nationality was lost) |
| (c) Passport no. and date and place of issue |
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6. | (a) Marital status |
| Date and place of marriage |
| (b) If husband or wife is dead give date and place of death |
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Particulars of Spouse |
7. | (a) Full name |
| Address |
| (b) Place and date of birth |
| (c) Citizenship at time of this application |
| (d) Place of employment and post held |
8. | Particulars of Children under 21 years of age to be registered. |
(a) Name | Date of Birth | Place of Birth | Place of Residence |
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(b) Full names of all other children | Date of Birth | Place of Birth | Present Address |
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9. | Particulars of Parents |
| (a) Father's full name |
| (b) Nationality (if dead, state nationality at the time of death) |
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| (c) Present address (if living) |
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10. | (a) Mother's full name before marriage |
| (b) Nationality (if dead, state nationality at the time of applicant's death) |
11. | Knowledge of the English Language |
| Sate whether fair, good or excellent |
12. | School/Universities attended by Applicant |
Institutions | Date | Certificate/ Diploma, Degrees |
From | To |
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Other Courses Pursued |
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13. | Profession or occupation—trade and special skills or other special qualifications |
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14. | State job experience including on-the-job training |
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| Particulars of employment during the last five (5) years in Saint Lucia: |
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15. | Financial Status |
| Each part of this section must be answered 'yes' or 'no' or, in the case of (d), 'not applicable'. If the answer to (b), (c) or (d) is 'yes' give dates in the second column. |
| (a) Are you financially solvent? ................................... | (c) Have you been bankrupt? ................................... |
| (b) Have you made any composition with creditors? ................................... | (d) if so, have you been discharged from bankruptcy? ................................... |
16. | Do you own property in Saint Lucia? Give particulars. |
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17. | Do you have any investments in Saint Lucia? Give particulars. |
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18. | Do you have any interest on lands in Saint Lucia for agricultural purposes? |
| If so, state particulars |
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19. | Date of entry in Saint Lucia with respect to this application. |
20. | (a) Is your period of stay here subject to any time condition under the Immigration Act. |
| Yes ––––– | No ––––– | If yes, give particulars. If no, furnish proof of resident status. |
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| (b) Where have you lived in Saint Lucia, and for how long? |
Addresses | Date | Total Length of Time |
From | To |
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| (c) Addresses of countries where you have lived in the last 8 years |
Name of Country | Dates |
From | To |
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| (continue on a separate sheet of paper if necessary) |
21. | Have you ever been deported or required to leave any country? (If yes, name country and give details). |
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22. | Court Proceedings |
| Details of criminal/civil proceedings taken against you whether in Saint Lucia or any other country which resulted in a conviction. (If the answer is none, write “NONE”) |
Nature of Proceedings/charge | Date | Place | Results/ Sentence |
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23. | Do you belong to any clubs, political parties, trade union organisations, friendly societies, co-operatives, civil or charitable organisations etc.? If so, give particulars. |
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24. | Approximate date of any previous application for registration. |
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25. | Reason for desiring citizenship of Saint Lucia |
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| Any other information which the applicant considers to be of assistance may be given. |
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Warning: | The giving of false information on this form can lead to imprisonment. |
Declaration: | |
Delete and initial the words in bracket if inapplicable. | I, (full name) .................................................. hereby apply to the Minister, for registration as a citizen of Saint Lucia (and for the registration of my minor children as indicated in section 8 above). |
I do solemnly and sincerely declare that the foregoing particulars in this application are true, and I make this solemn declaration conscientiously believing the same to be true. |
If, at any time before a certificate is issued to me, the accuracy of any of the foregoing particulars is affected by an alteration in circumstances, I undertake to inform the Minister in writing forthwith. |
Signature of Applicant:*............................................... |
Made and subscribed this day of , 20 . |
Before me (full name) |
At |
Address or | Signed .............................................. |
office stamp: |
Qualification:..................................... |
| (State whether Commissioner for Oaths, Justice of the Peace, Notary Royal or other authorised person). |
*Caution: Section 13 of the Citizenship of the Saint Lucia Act provides— |
“ Offence | 13. A person who, for the purposes of procuring anything to be done or not to be done in connection with the provisions of this Act knowingly or recklessly makes a statement which is false in a material particular commits an offence and is liable on summary conviction to a fine of $500 or to imprisonment for 6 months or to both such fine and imprisonment.” |
REFERENCE |
Name (in block letters) |
Full postal address |
I, the undersigned, hereby state that I am a citizen of Saint Lucia and that I am not the solicitor or agent or a relative of: |
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I support this application from my personal knowledge of and close acquaintance with the applicant for .......................................... years. |
I vouch for his/her good character and loyalty and am prepared to furnish full details about my knowledge of and acquaintance with the applicant. I have read the caution at the foot of the application. |
Date ........................................... | ..................................................... |
| Signature. |
REFERENCE |
Name (in block letters) |
Full postal address |
I, the undersigned, hereby state that I am a citizen of Saint Lucia and that I am not the solicitor or agent or a relative of: |
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I support this application from my personal knowledge of and close acquaintance with the applicant for ..................................... years. |
I vouch for his/her good character and loyalty and am prepared to furnish full details about my knowledge of and acquaintance with the applicant. I have read the caution at the foot of the application. |
Date ........................................... | ..................................................... |
| Signature. |