Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694232589592.pdf (Antigua and Barbuda)
THE ANTIGUA & BARBUDA SOCIAL SECURITY BOARD (SOCIAL SECURITY ACT 1972) EMPLOYERS REGISTRATION FORM This form must be completed and signed by the owner/partner/managing director/company secretary, within seven days of hiring your first employee.

When registering a company the articles of incorporation from the Antigua & Barbuda Intellectual and Property Commerce office must be presented.

Please print in block letters REGISTRATION NUMBER For Official Use Only 1.
Name of business: ________________________________________________________________________________ 2.

Legal classification:_______________________________________________________________________________ (sole ownership/partnership/company/off-shore company) 3.

Name(s) of owner(s):______________________________________________________________________________ ______________________________________________________________________________ 4.
Nature of business: _______________________________________________________________________________ 5.

Mailing address of business: _______________________________________________________________________ _______________________________________________________________________ 6.

Location of business: _____________________________________________________________________________ ___________________________________________________________________________ 7.
Contact Information: Telephone: __________________ __________________ _________________ Fax: __________________ ___ Email: ___________________________________________ 8.

Sector: _____________________________ (private/public) 9.

Date of first hire: _________/ __________/ ___________ 10.
Number of insurable employees: Please see reverse side List the name of the employee(s) & their rate of pay/salary below: NAME OF EMPLOYEE(S) EARNINGS ____________________________________________________________ Name(s) of Director(s): 1._________________________ 2.

_______________________ 3.

_________________________ 4.

_______________________ I hereby declare that the information given on this application is true and correct.
_________________________ _______________________ Name (in block letters) Signature _________________________ _______________________ Position held by signatory Date