(268) 462-0169

Central Housing and Planning Authority (CHAPA), Lower All Saints Road, St. John's, Antigua

enquiries@visitchapa.com

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CHAPA HOME INITIATIVE

Step 1 of 4

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SECTION A - PERSONAL INFORMATION
Hidden
Date submitted :
MM slash DD slash YYYY
Social Security Number:*
Passport Number*
Passport Expiration Date :*
MM slash DD slash YYYY
Surname :*
First Name :*
Other names:
Date of Birth :*
MM slash DD slash YYYY
Sex :*
- Male
- Female
Country of Birth :*
Nationality:*
Current Address :*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell :*
Work :
Home :
Marital Status*
- Single
- Married
- Widow(er)
- Divorced
Employers Name:*
Occupation*
Gross Monthly Income ($)*
Does your gross monthly income include:
- Pension
- Social Welfare
- Disability
- Other
Employers Address:*
Street Address City State / Province / Region ZIP / Postal Code Country
Financial commitment:
- Car Loan
- House Loan
- Land
- Other
Name of your Financial Institution(s):*
Name of your Life /Property Insurance Company:*
Are you the owner of the land?*
- Yes
- No
Please state the Owner’s Name:*
Reg. Section:*
Block #:*
Parcel #:*
Size:*
Land was purchased via:*
- CHAPA
- CROWN
- PRIVATE
Model Requested:

SECTION B - CO APPLICANT PERSONAL INFORMATION
Social Security Number:
Passport Number:
Expiration Date :
MM slash DD slash YYYY
Surname :
First Name :
Other :
Date of Birth :
MM slash DD slash YYYY
Sex :
- Male
- Female
Country of Birth :
Nationality:
Address :
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell:
Work :
Home :
Marital Status*
- Single
- Married
- Common Law
- Divorced
Employers Name:*
Occupation*
Gross Monthly Income ($)*
Does your gross monthly income include:
- Pension
- Social Welfare
- Disability
- Other
Employers Address:*
Street Address City State / Province / Region ZIP / Postal Code Country

BANKING INFORMATION
Banking information*
NAME OF BANK TYPE OF ACCOUNT
PERSONAL INFORMATION
Does anyone in your household currently use a controlled or illegal drug?*
- Yes
- No
Name the drug:*
Are you or any household member subject to lifetime registration as a sex offender?*
- Yes
- No
Name the member:*
Have you ever been evicted due to alcohol abuse that threatened the Health, safety or right to peaceful enjoyment of the unit of other residents or neighbors in the vicinity of your residence?*
- Yes
- No
ATTACHMENT TO APPLICATION
- Copy of passport for proof of citizenship
- Letter from Employer (for applicant and co-applicant)
- Bank Statement (for applicant and co-applicant)
- utility bill / proof of address (applicant and co-applicant)
- Land registrar/ land certificate (parcel of land)
Attachements
Drop files here or

Max. file size: 32 MB.
Applicant Personal Declaration and Certification
Consent*
- I declare that I have completed this application with true and correct information to the best of my knowledge. I also understand that in the event any information I have provided proves to be false, misleading and incorrect, that my application would become invalid and I would be rendered ineligible for the receipt of lands under the Central Housing and Planning Authority programme.
consent 2*
- I further agree to pay all prescribed fees and charges in connection failure to meet prescribe payments will result in forfeiture of down payments/deposit. At which point Central Housing and Planning Authority has the right repossess the land.
Signature Applicant:*
Date :
MM slash DD slash YYYY
Witness :*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Comments
This field is for validation purposes and should be left unchanged.

Central Housing and Planning Authority (CHAPA), P.O Box 868, Lower All Saints Road, St. John's, Antigua

enquiries@visitchapa.com

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