Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697641655313.pdf (Antigua and Barbuda)
Investment Confirmation Form AB4 The Government of Antigua and Barbuda Application for Registration as a Citizen of Antigua and Barbuda Citizenship by Investment Programme For Official Use Only Reference Number Agents Licence Number Date Received Version May 2021 | Copyright © 2014 Government of Antigua and Barbuda | All rights reserved | Copying this form is illegal 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 Male 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) ix) x) xi) xii) xiii) xiv) xv) xvi) xvii) xviii) xix) xx) Version May 2021 | Copyright © 2014 Government of Antigua and Barbuda | All rights reserved | Copying this form is illegal 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 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); or d) An investment in University of the West Indies Fund option in accordance with regulation 6A of the Antigua and Barbuda Citizenship by Investment (Amendment) Regulations (2018); Please complete only ONE of sections D – G, according to the type of investment you are making.
Section D: Real Estate (if applicable, will be greater than or equal to US$ 400,000 or 2 related applications at US$ 200,000 each, or single applicant at US$200,000) D1.

Real Estate Project D2.

Unit Name or Number D3.

Purchase Price (in US$) 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.
Yes No Section E: Contribution to the NDF: (Minimum contribution of US$ 100,000) E1.

NDF Contribution Amount (in US$) Section F: Investment in Business (if applicable, will be greater than or equal to US$1,500,000 for a single investor or under the collective business investment scheme, minimum investment of US$ 400,000 for each investor) F1.

Proposed or existing business name F2.

Proposed or existing business investment (in US$) F3.
If making a joint investment, the names of your business partners (attach additional sheet if space is insufficient) Version May 2021 | Copyright © 2014 Government of Antigua and Barbuda | All rights reserved | Copying this form is illegal Section G: Contribution to the University of the West Indies Fund: (Contribution of US$150,000.

Minimum of six (6) family members) G1.


UWI Contribution Amount (in US$) Section H: Government and Processing Fees Please calculate your government and processing fees according to the following schedule: Fees Processing fee – Family of 1 – 4 persons Processing fee – Family of 5 Processing fee – Family of 6 Processing fee – Family of 7 Processing fee – Each additional dependent H1.
Total required Government and Processing Fees (in US$) Due diligence fee – Principal applicant Due diligence fee – Spouse Due diligence fee – Per Dependent child aged 0 – 11 Due diligence fee – Per Dependent child aged 12 – 17 Due diligence fee – Per adult Dependent aged 18 and over H2.
Total required Due Diligence Fees (in US$) US$ 30,000 US$ 45,000 US$ 60,000 US$ 75,000 US$ 15,000 US$ 7,500 US$ 7,500 US$ 0 US$ 2,000 US$ 4,000 IMPORTANT: Please note that you are required to submit with citizenship application: 1.

Ten percent (10%) of the required Government and Processing Fee, and 2.

The full amount of the required Due Diligence Fees as specified above.
Section I: 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 Version May 2021 | Copyright © 2014 Government of Antigua and Barbuda | All rights reserved | Copying this form is illegal Section J: NDF Contribution Escrow Payment Instructions (if applicable) Please pay the total amount in US$ funds as specified above into the National Development Fund and UWI Fund Account, when requested to do so, according to the following bank wire/payment instructions.
Banking Option #1 Banking Option #2 Pay to: (Intermediary Bank) For Credit to: (Beneficiary Bank) For Final Credit Bank of America 701 Brickell Avenue, 6th Floor Miami, Florida, USA, 33131 ABA Number: 026009593 SWIFT: BOFAUS3M 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 57A: The Reserve Trust Company 5600 Quebec St. Suite 205D ABA # : 102007558 For Further Credit to: 59: Global Bank of Commerce Friars Hill Road, St. John’s, Antigua Account # 4500 4500033026 01 For Final Credit to: 70: Citizenship by Investment Unit Account Number: 100-021-49 Nature of Payment is to be included in SWIFT Field 70 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.
 Where the funds are being sent by a third party, the following is submitted: From Company – Interest in the company on company letterhead indicating position If shareholder; percentage ownership Incorporation documents     Most recent audited financial statements From Individual – Introductory letter from remitter stating relationship to the applicant   Passport bio page  Proof of source of funds/wealth (eg.
Employment letter/contract)  The transfer includes an additional US$ 70 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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