Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694420327985.pdf (Saint Kitts and Nevis)
SAINT CHRISTOPHER AND NEVIS INLAND REVENUE DEPARTMENT INDIVIDUAL ENTERPRISE REGISTRATION SECTION 1 - APPLICANT TAXPAYER NO.

(TIN): SOCIAL SECURITY NO.

: LAST NAME: MIDDLE NAME(S): DATE OF BIRTH: DAY ADDRESS: / MONTH YEAR / CITY / TOWN / VILLAGE: COUNTRY: E-MAIL ADDRESS: SECTION 2 - ENTERPRISE DETAILS ENTERPRISE NAME: TRADE NAME: START DATE: DAY RESIDENT: YES ADDRESS: MONTH / YEAR / NO FIRST NAME: STATE: CODE: END DATE: DAY SOCIAL SECURITY NO.
: / MONTH / CITY / TOWN / VILLAGE: PARISH: ISLAND: ST. KITTS NEVIS PHONE: FAX : MOBILE : E-MAIL ADDRESS: CONTACT NAME: CONTACT POSITION: SECTION 3 - BUSINESS ACTIVITY DETAILS PRIMARY BUSINESS ACTIVITY: ESTIMATED GROSS SALES: SECONDARY BUSINESS ACTIVITY: ESTIMATED GROSS SALES: PAGE 1 OF 2 SECTION 4 - ESTABLISHMENTS / PHYSICAL LOCATIONS 1.

2.
2.

HEAD OFFICE YES NO NAME: ADDRESS: CITY / TOWN / VILLAGE: ISLAND: HEAD OFFICE YES NO NAME: ADDRESS: CITY / TOWN / VILLAGE: ISLAND: SECTION 5 - DECLARATION PARISH: PARISH: I declare that the information given on this form is to the best of my knowledge and belief true and correct and that I have the authority to disclose the information provided.

I understand that the Saint Christopher and Nevis Inland Revenue Department reserves the right to review and veify the information provided.
Please be aware that a person who makes a false declaration commits an offence under Section 5 of the Perjury Act, 2005 of the laws of Saint Christopher and Nevis and that person is liable to imprisonment for a term of seven (7) years or to a fine of thirty-thousand ($ 30,000.00) dollars.

FULL NAME: TITLE: TAXPAYER NO.

(TIN): VAT NO.

: SIGNATURE DATE: DAY MONTH / YEAR / SECTION 6 - INLAND REVENUE DEPARTMENT USE ONLY SOCIAL SECURITY NO.
: PRIMARY ISIC CODE: SECONDARY ISIC CODE: TAXES AND LICENCES REGISTERED Business and Occupation Licence Unincorporated Business Tax (UBT) PROCESSED BY: VERIFIED BY: APPROVED BY: DAY DAY DAY MONTH / MONTH / MONTH / YEAR / YEAR / YEAR / SIGNATURE SIGNATURE SIGNATURE PAGE 2 OF 2