(a) Insert name of place | (a) |
(b) Christian name and surname of the applicant in full | I (b) the undersigned at |
present residing at hereby |
(c) Strike out such of the paragraphs (1) to (4) as do not apply | declare that I am a British subject and that (c) |
(1) I was born in Saint Lucia; |
(2) I was born of parents who at the time of my birth were domiciled or ordinarily resident in Saint Lucia; |
(3) I am domiciled in Saint Lucia; |
| (4) I have been ordinarily resident in Saint Lucia for a period of 7 years or more, and since completion of such period of residence I have not been ordinarily resident in any place outside Saint Lucia continuously for a period of 7 years or more; |
| (5) I am a dependent of a person to whom any one of the paragraphs (1), (2), (3), and (4) above mentioned applies; and that I therefore belong to Saint Lucia |
| in terms of section 2 of the Immigration Act. |
I propose to depart from Saint Lucia on the |
day of 20 , and I intend to return to |
Saint Lucia; and I hereby apply that a re-entry permit be issued in my favour. |
Dated the day of 20 |
To the Chief Immigration Officer, |
or to the Immigration Officer, as the case may be |
| |
| Appellant |