General Application

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General Application

*Online applications will receive an email confirmation of receipt, please allow us up to 48 hours to process the application and provide further updates.

Heritage Quay Store
Vendors Mall Duty Free
Food Court
Public Market Store
West Bus Station

First Name

Last Name

Email Address

Phone Number

Birth Date

Gender

Nationality

Passport No.

Place of Issue

Date of Issue

Work Permit Number

Free Movement Indefinite Stay

Street Address

City

Parish

Country

Intellectual Property Registration/Receipt No:

Tax ID No. (Inland Revenue)

Social Security No. (Personal)

Social Security No. (Business)

Medical Benefits No. (Personal)

Medical Benefits No. (Business)

Board of Education Registration No

Type of Business

Business Age (Number of years applicant has been carrying on such business)

Business Address

List of goods or articles to be sold/Activity to be undertaken

Reference 1 - First Name

Reference 1 - Last Name

Reference 1 - Address

Reference 2 - First Name

Reference 2 - Last Name

Reference 2 - Address

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected.

General Application

Property/Location

Personal Information

References - (Name of two persons known to the applicant in Antigua & Barbuda)

Terms & Conditions

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