Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694420267885.pdf (Saint Kitts and Nevis)
SAINT CHRISTOPHER AND NEVIS INLAND REVENUE DEPARTMENT NON-INDIVIDUAL ENTERPRISE REGISTRATION SECTION 1 - APPLICANT CORPORATION LIMITED PARTNERSHIP JOINT VENTURE NON-PROFIT OTHER (SPECIFY) REGISTERED NAME: REGISTRATION NO.

: TRADE NAME: START DATE: DAY FISCAL YEAR START: DAY RESIDENT: YES / MONTH / MONTH / YEAR NO REG.

DATE: DAY / MONTH END DATE: DAY FISCAL YEAR END: DAY / MONTH / MONTH SOCIAL SECURITY NO.
: / YEAR / YEAR MAILING ADDRESS: CITY / TOWN / VILLAGE: COUNTRY: PHONE: E-MAIL ADDRESS: CONTACT NAME: CONTACT POSITION: PARISH: CODE: FAX : MOBILE : 1.

2.

3.

Details of directors, partners, owners of the enterprise are to be completed on page 3.

Additional details on physical establishments (locations) of the company are to be completed on page 4.

Details on joint venture partners are to be completed on page 5.
SECTION 2 - BUSINESS ACTIVITY DETAILS PRIMARY BUSINESS ACTIVITY: ESTIMATED GROSS SALES: SECONDARY BUSINESS ACTIVITY: ESTIMATED GROSS SALES: PAGE 1 OF 6 SECTION 3 - REPRESENTATION REPRESENTATIVE NAME: POSITION: PHONE: FAX : MOBILE : LAWYER TRUSTEE LIQUIDATOR AGENT OTHER (SPECIFY SECTION 4 - ACCOUNTANT NAME: ADDRESS: CITY / TOWN / VILLAGE: MAILING ADDRESS: CITY / TOWN / VILLAGE: COUNTRY: PHONE: E-MAIL ADDRESS: SECTION 5 - FOREIGN PARENT REGISTERED NAME: BUSINESS ADDRESS: CITY / TOWN / VILLAGE: MAILING ADDRESS: CITY / TOWN / VILLAGE: COUNTRY: CONTACT: POSITION: PHONE: E-MAIL ADDRESS: PARISH: PARISH: CODE: FAX : MOBILE : STATE: STATE: CODE: FAX : PAGE 2 OF 6 SECTION 6 - FINANCIAL DETAILS This page can be copied if additional space is required.
LOCAL BANK BANK NAME: ADDRESS: PHONE: E-MAIL ADDRESS: ACCOUNT NUMBER: FOREIGN BANK BANK NAME: ADDRESS: PHONE: E-MAIL ADDRESS: ACCOUNT NUMBER: FAX: FAX: ACCOUNT NUMBER: ACCOUNT NUMBER: SECTION 7 - ESTABLISHMENTS / PHYSICAL LOCATIONS 1.

2.

3.
2.

3.

HEAD OFFICE YES NO TRADE NAME: ADDRESS: CITY / TOWN / VILLAGE: PARISH: ISLAND: HEAD OFFICE YES NO TRADE NAME: ADDRESS: CITY / TOWN / VILLAGE: PARISH: ISLAND: HEAD OFFICE YES NO TRADE NAME: ADDRESS: CITY / TOWN / VILLAGE: PARISH: ISLAND: PAGE 4 OF 6 SECTION 8 - OWNERS / DIRECTORS This page may be copied if additional space is required.

1.

TAXPAYER NO.

(TIN): LAST NAME: MIDDLE NAME(S): DATE OF BIRTH: ADDRESS: CITY / TOWN / VILLAGE: COUNTRY: E-MAIL ADDRESS: POSITION: 2.

TAXPAYER NO.
TAXPAYER NO.

(TIN): LAST NAME: MIDDLE NAME(S): DATE OF BIRTH: ADDRESS: CITY / TOWN / VILLAGE: COUNTRY: E-MAIL ADDRESS: POSITION: 3.

TAXPAYER NO.

(TIN): LAST NAME: MIDDLE NAME(S): DATE OF BIRTH: ADDRESS: CITY / TOWN / VILLAGE: COUNTRY: E-MAIL ADDRESS: POSITION: SOCIAL SECURITY NO.

: FIRST NAME: STATE: CODE: PERCENT OWNED: SOCIAL SECURITY NO.

: FIRST NAME: STATE: CODE: PERCENT OWNED: SOCIAL SECURITY NO.
: FIRST NAME: STATE: CODE: PERCENT OWNED: PAGE 3 OF 6 SECTION 1 - CONTINUED (JOINT VENTURE PARTNERS) 1.

TAXPAYER NO.

(TIN): SOCIAL SECURITY NO.

: NAME: ADDRESS: CITY / TOWN / VILLAGE: COUNTRY: E-MAIL ADDRESS: STATE: CODE: 2.

TAXPAYER NO.

(TIN): SOCIAL SECURITY NO.

: NAME: ADDRESS: CITY / TOWN / VILLAGE: COUNTRY: E-MAIL ADDRESS: STATE: CODE: 3.

TAXPAYER NO.

(TIN): SOCIAL SECURITY NO.

: NAME: ADDRESS: CITY / TOWN / VILLAGE: COUNTRY: E-MAIL ADDRESS: STATE: CODE: 4.

TAXPAYER NO.
TAXPAYER NO.

(TIN): SOCIAL SECURITY NO.

: NAME: ADDRESS: CITY / TOWN / VILLAGE: COUNTRY: E-MAIL ADDRESS: STATE: CODE: PAGE 5 OF 6 SECTION 9 - DECLARATION 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: SIGNATURE DATE: DAY MONTH / YEAR / SECTION 10 - INLAND REVENUE DEPARTMENT USE ONLY TAXPAYER NO.

(TIN): SOCIAL SECURITY NO.

: VAT NO.

: ENTERPRISE NO.


: TAXES AND LICENCES REGISTERED Business and Occupation Licence Income Tax (corporation) PRIMARY ISIC CODE: SECONDARY ISIC CODE: DAY DAY DAY MONTH MONTH MONTH / / / YEAR YEAR YEAR / / / PROCESSED BY: VERIFIED BY: APPROVED BY: 1: 2: 3: 4: SIGNATURE SIGNATURE SIGNATURE PAGE 6 OF 6