APPLICATION FORM

*Please note that this is not a Job Application Form

Please address the errors below to proceed:

Application Category

(Please select an application Category below)

Single - USD$1500.00
Couple (Applicant + 1 dependent) - USD$2000.00
Family (Applicant + up to 3 dependents) - USD$3000.00

Please Note: A family of more than 3 dependents will incur an additional fee of $650 per additional dependent.

Personal Info

(*Required information)

First Name *

Middle Name

Last Name *

Gender *

Female Male

Date of Birth *

Marital Status *

Country of Birth *

Country of Citizenship *

Former Nationality (if applicable)

Additional Info

Birth Certificate (JPG/JPEG or PDF) *

Medical Insurance (JPG/JPEG or PDF) *

Marriage Certificate (PDF) (if applicable)

Dependents

Number of Dependents

* I hereby declare that I, or my dependant(s) shall not accept any employment from or offer any services to a citizen, permanent resident, immigrant, work permit holder or any person or entity carrying on business in Antigua and Barbuda.

Passport Info

Passport Picture (JPG/JPEG) *

Passport Number *

Country of Issue *

Date of Issue *

Date of Expiration *

Proposed Date of Entry *

Passport Bio Data (JPG/JPEG) *

Police Letter of Character (PDF) *

Have you ever been convicted of a serious criminal offence? *

No Yes

If Yes, Year of Conviction

Contact Info

Address Line 1 *

Address Line 2

City *

State/Province/Region

Zip/Postal Code

Country *

Mobile Phone

Telephone Number

Applicant Email *

Emergency Contact Info

Emergency Contact Name *

Emergency Contact Number *

Income Info

I work for a company
I am self-employed

Company Name *

Telephone Number

Company Email *

Company Address Line 1 *

Company Address Line 2

City *

Zip/Postal Code

State/Province/Region

Country *

Occupation * * Brief description of type of work/nature of business in which you're currently engaged

PROOF OF INCOME AND FUNDS

*Proof of Income and Funds (PDF)

If Employed by a Business

*Job Letter (PDF)

*Pay Slip (PDF)

* Business Registration (PDF)

Income Declaration

* I certify that I expect to earn a minimum income of US$50,000.00 (Other equivalent currency) during each of the two years in Antigua and Barbuda, and I have the means to support myself, my spouse and any dependants accompanying me, during my stay.

Summary Info

Application Classification: Single

Applicant Info

Applicant Name:	Jane Doe
Gender:	Female
Date of Birth:	05 Aug 1964
Marital Status:	Single

Country of Birth:	Antigua
Country of Citizenship:	Antigua
Former Nationality:	none

Documents	Uploaded
Birth Cert:
Medical Insurance:
Marriage Cert:

Contact Info

Mobile Phone:
Telephone:
Emergency Contact Name:
Emergency Contact Number:

Address Line 1:
Address Line 2:
City:
Zip/Postal Code:

State/Province/Region:	London
Country:	United Kingdom
Email:	DigitalNomad@email.com

Income Info

Self-Employed:	Self Employed
Company Name:	I Love Carnival
Company Number:	1 268 720 0000
Company Email:	company@example.gov.ag
Occupation:	Web-Developer

Company Address 1:	Blueberry Lane
Company Address 2:
City:	Black Sea
Zip/Postal Code:

State/Province/Region:	London
Country:	United Kingdom

Documents	Uploaded
Proof of Income:	YES
Job Letter:	YES
Pay Slip:	YES
Business Registration:	YES

Passport Info

Passport Number:
Country Of Issue:
Date of Issue:	08 FEB 2016
Date of Expiration:	08 FEB 2016
Proposed Date of Entry:	08 FEB 2016

Documents	Uploaded
Passport Pic:
Passport Bio:
Police Clearance:

Convicted of Serious Offence:
Year of Conviction:

I hereby certify that the information given by me in this application is true and correct to the best of my knowledge. I understand and agree that any false information, misrepresentation, or omission of facts in this application and the application process, may be justification for refusal of entry or revocation of status.

APPLICATION FORM

*Please note that this is not a Job Application Form

APPLICATION FORM

Your application is being submitted. Please do not press the back button

Application Category

Personal Info

Additional Info

Dependents

Passport Info

Contact Info

Emergency Contact Info

Income Info

PROOF OF INCOME AND FUNDS

If Employed by a Business

Income Declaration

Summary Info

Application Classification: Single

Applicant Info

Contact Info

Income Info

Passport Info