Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697630472974.pdf (Antigua and Barbuda)
THE ANTIGUA & BARBUDA SOCIAL SECURITY BOARD (SOCIAL SECURITY ACT 1972) SELF EMPLOYED REGISTRATION FORM This form must be completed and signed by the applicant and must be accompanied with a valid passport or a government picture identification.

The earnings given are only subject to a change on a semi-annual basis.

Social Security Number If you do not have a social security number you need to be registered as an employee first before proceeding with this form.
Name of applicant: ……………………………………………………………………………… Business Start Date: ……………………………………………………………………………...

Location of Business: ……………………………………………………………………………….

Mailing Address: …………………………………………………………………………………….

Nature of Business: …………………………………………………………………….


Tel #: …………………………………… email address: …………………………….. Reported earnings $ …………………… 10% …………………………………….. Signature of Applicant: ………………………………………………………………… All applicants need to supply a birth certificate and government issued ID if born in Antigua & Barbuda or a valid passport if born outside of Antigua & Barbuda OFFICIAL USE ONLY ISIC CODE: ……………………………..
INSPECTOR NO: ………………………….. RECIVED DATE OF APPLICATION: ………………………………………………………………… COMMENTS…………………………………………………………………………………………… …………………………………………………………………………………………………………….

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