Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694878577849.pdf (Antigua and Barbuda)
Representatives and Service Providers AB6 The Government of Antigua and Barbuda Application for Registration as an Authorised Representative Citizenship by Investment Programme For Official Use Only Date Received Reference Number Version January 2022 | Copyright © 2013 Government of Antigua and Barbuda | All rights reserved | Copying this form is illegal Application Form – Representatives and Service Providers Please read the following explanatory notes carefully.
In accordance with Section 11 of the Antigua and Barbuda Citizenship by Investment Act (2013), the Unit shall from time to time by contract appoint representatives and service providers to promote, advertise, and disseminate information on the citizenship by investment program.

The Unit shall appoint only representatives and service providers whose professional qualification, ability, resources, expertise, integrity and conduct confirm to the guidelines issued by the Unit.
Unless approved and in compliance with the guidelines issued by the Unit, no promotional information, or advertisement in relation to the citizenship by investment program shall be published or disseminated publicly.
Any person found to contravene this, commits an offence and is liable on summary conviction to a fine not exceeding EC$15,000.00 In addition, the Unit will from time to time contract with service providers outside of the sphere of promotion, advertising and dissemination of information to provide support services to the Unit.

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Please complete all sections in BLOCK letters.

All fields are compulsory.


Please post or hand deliver the original completed application form, supporting documents and Cheque of US$5000.00 to: The Citizenship by Investment Unit, Sir John E. St. Luce Finance and Conference Center, Factory Road, St. John’s Antigua.

If the application form or the required documents received are not in order, the application may be rejected.
Please attach the following: For the Company detailed in Section A, please provide certified true copies of the following documents: a. b. c. d. Certificate of Incorporation (or other appropriate certificate of registration or licensing); Memorandum and Articles of Association; Copies of AML/KYC policies; Notarized Character Reference Letter or Reference Letter written by an independent individual, associated body or corporation; e. Copy of Share Certificate; f. ID documents for Owners, Directors and Executive Management; g. Proof of Business address 5.
Please attach a signed and dated cover letter (on headed paper as applicable) officially tendering this application.

This letter should detail the applicant’s professional standing, ability, resources, experience and integrity.

You may choose to renew for up to 3 years.

Version January 2022 | Copyright © 2013 Government of Antigua and Barbuda | All rights reserved | Copying this form is illegal Section A: Company Information A1.

Company name A2.

Date of incorporation or registration A3.


Any trading names A4.

Type (e.g.

private limited company) D D M M Y Y Y Y A5.

Official identification number A6.

Country of incorporation A7.

Registered office address A8.

Mailing address A9 Principal place of business/operations (if different from registered address) A10.

Nature of activities and jurisdictional sphere – Please provide a sufficient description of the type of business undertaken and the jurisdictions in which the business operates A11.
Web address – Please list all business websites and any domain names registered or intended for use in relation to the Antigua and Barbuda Citizenship by investment program A12.

Email address Version January 2022 | Copyright © 2013 Government of Antigua and Barbuda | All rights reserved | Copying this form is illegal Section B: Company Information Please list below the principal points of contact within your company and the local operational contact should this differ.

B1.
B1.

Title and full legal name  Mr  Mrs  Miss  Ms  Other ........................... B2.

Role within your organization B3.

Office Address B5.

Telephone B6.

Cell/Mobile number B7.

Fax B8.
ID details of Owners, Directors, Executive Management Name on ID Position within the organization Name of ID Issuing country ID number Place of issue Date of issue Date of expiration Please tick here  if there is more information at the end of this form or on an attached sheet For additional information, please complete Section D Version January 2022 | Copyright © 2013 Government of Antigua and Barbuda | All rights reserved | Copying this form is illegal Section C. Geographical jurisdiction(s) Please list below the targeted geographical jurisdiction(s) for marketing.
(e.g.
the location of the markets in which you intend to do business) Version January 2022 | Copyright © 2013 Government of Antigua and Barbuda | All rights reserved | Copying this form is illegal Section D. Additional Information Additional information and/or description of attachments Question number Version January 2022 | Copyright © 2013 Government of Antigua and Barbuda | All rights reserved | Copying this form is illegal Section E. Certification of Documents Document certification must be undertaken by a Notary Public or any authorized certifier within the jurisdiction of origin.
How to certify a copy of an original document: The suitable certifier must certify: 1.
2. that they have seen the original documentation (verifying identity or residential address) the certified document is a true copy of the original The certification wording should be as follows: “Certified true copy of the original document” Version January 2022 | Copyright © 2013 Government of Antigua and Barbuda | All rights reserved | Copying this form is illegal Version January 2022 | Copyright © 2013 Government of Antigua and Barbuda | All rights reserved | Copying this form is illegal