Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698831871480.pdf (Saint Vincent and the Grenadines)
MINISTRY OF NATIONAL MOBILIZATION, SOCIAL DEVELOPMENT, FAMILY, GENDER AFFAIRS, YOUTH, HOUSING, AND INFORMAL HUMAN SETTLEMENT REGISTRATION FOR INCOME SUPPORT (NON-FARMER WORKERS/SELF EMPLOYED) Title:_____________ Date: _____________________________ Last Name:_____________________ First Name: ________________________ National ID No.

:________________ NIS No.

: ___________________________ Residential Address: _____________________________________________________ Telephone No.
:__________________ Occupation:_________________________ (Tick as appropriate) Employed ☐ Self- Employed ☐ No.
of Years:______ ---------------------------------------------------------------------------------------------------------------- For Non-Farm Workers Only: Business/ Employer’s Name: _____________________ Address of Business: _______________ _______________________________ Applicant’s Signature ---------------------------------------------------------------------------------------------------------------- Name of Business (if applicable):_____________________________________________ For Self-Employed Only: Nature of Business:__________________ Liquor/ Trader’s License No.
:____________ _______________________________ Applicant’s Signature Employer’s Certification for Non-Farmer Workers I hereby certify that the person named above is employed in my business as a ___________________for the last ______ months ☐/ years ☐ and further declare that the information provided is truthful and valid.

Full Name (Block Letters): -__________________________________________________ National ID:______________ Tel.

No.
No.

:-______________ Address_______________ ______________________ Employer’s Signature ______________________ Date: ---------------------------------------------------------------------------------------------------------------- Certification for Self-Employed (to be certified by a Justice of the Peace or Gazetted Police Officer or Ordained Pastor) I hereby certify that the person named above is known to me and is an own account business operator as stated above.
To the best of me knowledge the information provided is accurate and valid.

Full Name (Block Letters): -_____________________________ Qualification:_____________ National ID:____________ Tel.

No.
No.

:-____________ Address_______________________ ________________________ Certifier’s Signature __________________ Date _____________________ Certifier’s Stamp -------------------------------------FOR OFFICIAL USE ONLY-------------------------------------- _______________________________________ Verified by: _______________________________ Date: Comments: Approved ☐ Not Approved ☐ _______________________________________ Approved by: Date ______________________________