APPLICATION FORM FOR RETIRING IN BELIZE

Please print and mail to:                            Contact Information:
Belize Tourism Board                              Tel: +501-223-1913
P.O. Box 325                                                  +501-223-1910
3 ½ Miles Northern Highway                          +501-223-1825
New Horizon Bldg.                                   Fax: +501-223-1943          
Belize City, BELIZE                                  Toll Free: 1-800-624-0686

Important:

1. Please read all the instructions carefully before completing this form.
2. All particulars must be fully stated in block letters
3. Incorrect or incomplete statements may result in delay or refusal of the application. If any  error is discovered after status has been granted the applicant’s status may be revoked.
4. Applicants may use the services of a local attorney or accountant when processing the application.

PERSONAL INFORMATION

1. Full Name:

2. Name at Birth: (if different from above)

3. Date of Birth:

Month:

 Day:

Year:

4. Place and Country of Birth:

 5. Nationality:

6. Permanent Address: (In Full)

7. Intended Address in Belize: (In Full)

8. Passport Number:

9. Place of Issue:

10. Date Issued:

11. Expiration Date:

12. Telephone:

13. Fax:

14. Email:

15. Marital Status: (Circle One)

   Single                        Divorced  

   Married                     Widowed  

16. Sex: (Circle One)

     Male                       Female 

17. Contact information if application is processed by an agent:

FAMILY INFORMATION

18. Details of dependents accompanying applicant to Belize. (Attach color copy of all passport pages)

Name

Relationship

Date of Birth

Place of Birth

Nationality

OTHER PERSONAL INFORMATION

19. Will you or your dependants import any personal effects into Belize? (Circle One)

        Yes                    No

20. If YES, state the estimated value:

21. Will you or your dependants import a means of transportation into Belize? (Circle One)

        Yes                    No

22. If YES, state:

TYPE ____________________________ MAKE ____________________________

YEAR ____________________________ MODEL _______________________________

23. Education of Applicant (Number of Years Completed)

PRIMARY           _______________     YEARS  ________

SECONDARY     _______________     YEARS  ________

TERTIARY         _______________      YEARS  ________

24. Languages Spoken: (State Proficiency) ___________________________

_______________________________________________________________

_______________________________________________________________

SIGNATURES

I certify that to the best of my knowledge and belief, the particulars given in this application are correct.

Signature of Applicant:

Date:

Name in Block Letters:

FOR OFFICIAL USE ONLY

Director of Product Development: ___________________________

Date Received: _____________________________________

Approved Disapproved

Director of Tourism: ____________________________________________

Date: _________________________________________________________

Comments: _____________________________________________________

_______________________________________________________________

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