Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697633051957.pdf (Antigua and Barbuda)
Investment Confirmation Form AB4 illegal Version5Mar2018 | Copyright © 2014 Government of Antigua and Barbuda | All rights reserved | Copying this form is The Government of Antigua and Barbuda Application for Registration as a Citizen of Antigua and Barbuda Citizenship by Investment Program For Official Use Only Reference Number Agents Licence Number Date Received illegal Version5Mar2018 | Copyright © 2014 Government of Antigua and Barbuda | All rights reserved | Copying this form is Investment Confirmation Form This Investment Confirmation form is to be completed in English by the main applicant only.
Family applicants should be mentioned in section B of this form and the total amounts calculated according to the appropriate investment.

Section A: Your Personal Details A1.

Surname or Family Name (as shown in passport) A2.

First or Given Name(s) (as shown in passport) A3.

Place and Country of Birth A4.

Date of birth A5.

Gender D D M M Y Y Y Y o Male o Female Section B: Family Details B1.
Details of Family Members to be included in the Application Surname/First Name Date of Birth Relationship to main applicant i) ii) iii) iv) v) vi) vii) viii) Section C: Citizenship Investment Criteria “Citizenship Investment” means: a) The purchase of real estate in an approved project, in accordance with regulation 6 of the Antigua and Barbuda Citizenship by Investment Act (2013); or b) A contribution to the National Development Fund (“NDF”) in accordance with regulation 7 of the Antigua and Barbuda Citizenship by Investment Act (2013); or illegal Version5Mar2018 | Copyright © 2014 Government of Antigua and Barbuda | All rights reserved | Copying this form is c) An investment in a business in Antigua and Barbuda in accordance with regulation 9 of the Antigua and Barbuda Citizenship by Investment Act (2013); Please complete only ONE of sections D – F, according to the type of investment you are making.
Section D: Real Estate (if applicable, will be greater than USD 400,000.00) D1.

Real Estate Project D2.

Unit Name or Number D3.

Purchase Price (in USD) D4.

Please tick here to confirm that you are including an original, executed, purchase and sale agreement between yourself and the developer and an escrow agreement with your application.

o Yes o No Section E: Contribution to the NDF: (Under the Limited Time Offer, USD 100,000 – 1st November, 2017 to 31st October, 2018) E1.
NDF Contribution Amount (in USD) Section F: Investment in Business (if applicable, will be greater than USD1,500,000 or under the collective business investment scheme USD 400,000) F1.

Proposed or existing business name F2.

Proposed or existing business investment (in USD) F3.
If making a joint investment, the names of your business partners illegal Version5Mar2018 | Copyright © 2014 Government of Antigua and Barbuda | All rights reserved | Copying this form is Section G: Government and Processing Fees Please calculate your government and processing fees according to the following schedule: Fees Processing fee – Family of 1 – 4 persons USD 25,000 Processing fee – Family of 1 – 4 persons (Real Estate and Business Investment) USD 50,000 Processing fee – Family of 5 Processing fee – Family of 6 Processing fee – Family of 7 Processing fee – Each additional dependent G1.
Total required Government and Processing Fees (in USD) Due diligence fee – Principal applicant Due diligence fee – Spouse Due diligence fee – Per Dependent child aged 0 – 12 Due diligence fee – Per Dependent child aged 12 – 17 Due diligence fee – Per Dependent child aged 18 – 25 Due diligence fee – Per Dependent parent aged over 65 G2.
Total required Due Diligence Fees (in USD) USD 40,000 USD 55,000 USD 70,000 USD 15,000 USD 7,500 USD 7,500 USD 0 USD 2,000 USD 4,000 USD 4,000 IMPORTANT: Please note that you are required to accompany the submitted citizenship application with: 1.

Ten percent (10%) of the required Government and Processing Fee, and illegal Version5Mar2018 | Copyright © 2014 Government of Antigua and Barbuda | All rights reserved | Copying this form is 2.
The full amount of the required Due Diligence Fees as specified above.

Section H: Investment Declaration I herewith confirm that I will invest the amount declared above, to be considered my investment which makes me eligible for Citizenship by Investment in Antigua and Barbuda under the Antigua and Barbuda Citizenship by Investment Act (2013).
Place and Date Signature of Main Applicant Section I: NDF Contribution Escrow Payment Instructions (if applicable) Please pay the total amount in US$ funds as specified above into the National Development Fund Account, when requested to do so, according to the following bank wire/payment instructions.

Pay to: Bank of America 701 Brickell Avenue, 6th Floor Miami Florida, 33131 USA ABA Number: 026009593 SWIFT: BOFAUS3M For credit to: Antigua Commercial Bank Thames and St Mary’s Streets P. O.
Box 95 St. John’s Antigua Routing Number: 1901721716 SWIFT: ANCBAGAG For final credit to: Account Name: Citizenship by Investment Account Number: 110000230 Important – Please Read carefully You must make sure that; • You include with the payment, the reference provided by the C.I.U., upon approval of your application, so that your payment can be properly recorded.
The payment may be made from an account other than an account in your personal name, but your complete name and reference number on the approved letter, must appear as reference with the wire transfer.

illegal Version5Mar2018 | Copyright © 2014 Government of Antigua and Barbuda | All rights reserved | Copying this form is • The transfer includes an additional US$ 70.00 in respect of the charges incurred by the Antigua Commercial Bank in Antigua and Barbuda upon receipt.
• You instruct your bank to cover all transfer charges, including the charges of corresponding banks.

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