| 1. Surname at present
and any other surname used at any time |
|
| 2. Full Christian
Names |
|
| 3. Present Address
|
|
| 4. Permanent Address
(if different from present address) |
|
| 5. Date of Birth
|
|
| 6. Place of Birth
|
|
| 7. Nationality
- Now and at Birth - date of any change and place at which
such change was recorded |
|
| 8. Description:
Height, built, colour of eyes, Marks |
|
| 9. Schools attended
with dates of attendance |
|
| 10. Languages spoken
|
|
| 11. Dates of marriage
of applicant and if divorced, dates of such divorce and
place where granted |
|
| 12. (a) Present
occupation and place of occupation |
|
|
(b) Other occupations since leaving school |
|
| 13. Proposed source
of Income while resident in the Federation |
|
| 14. Particulars
of Income (Give approximate figure per annum) |
|
| 15. Name, Address,
Nationality and occupation of mother, father, sisters, brothers,
wife, or husband. if deceased, give date of death. |
|
| 16. All countries
where applicant resided with dates of entering and leaving
|
|
| 17. Last date of
entry into the Federation of St. Kitts and Nevis |
|
| 18. Full Passport
particulars |
|
| 19. Whether accompanied
by or associating with any other person also visiting |
|
| 20. Details of
previous visits to the Federation |
|
| 21. Intended place
of residence whilst here and duration of visit |
|
| 22. Full details
of persons with whom subject will be staying or conducting
business |
|
| 23. Details of
aircraft Flight No. or method of travel to the Federation
|
|
| 24. Reason for
desiring residence in the Federation |
|
| Signature of Applicant:
Date: |