(268) 462-0169

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

enquiries@visitchapa.com

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LAND & HOUSING APPLICATION FORM

Step 1 of 4

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LAND & HOUSING APPLICATION FORM
I am applying for*
- Land
- Housing
Location Requested:*
SECTION A - PERSONAL INFORMATION
Hidden
Date Received :
MM slash DD slash YYYY
Social Security Number:*
Passport Number*
Passport 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*
Employers Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Gross Monthly Income*
Does your gross monthly income include:
- Pension
- Social Welfare
- Disability
- Other
Please specify*
Financial Commitment
- Car Loan
- House Loan
- Land
- Other
Please specify*
Do you own any land?*
- Yes
- No
Location of the land?*
Do you own or are you part owner of any property?*
- Yes
- No
Location of the property?*
Are you squatting?*
- Yes
- No
Please specify:*
- Chapa
- Crown
- Private
Please specify since when*
MM slash DD slash YYYY
Location*

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
Employers Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Gross Monthly Income
Does your gross monthly income include:
- Pension
- Social Welfare
- Disability
- Other
Please specify

ATTACHMENT TO APPLICATION
- Copy of valid passport both front and picture page.
- Job letter
- Recent Pay slip
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.
consent2*
- 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 of Applicant*
Date :
MM slash DD slash YYYY
Witness:*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
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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