Investor Personal History Form



         
          


 




            
                

                        Personal Information
                


                
                        

                                

                                               
                                               
                                   

       
                                   

                                   
                                   
                                   

       
                                   

                                           
                                           
                                   


                                   

                                        
                                        
                                


                                

                        

                  
                        
                 

                 


                
                        

                                

                                        
                                        
                                

                                

                                        
                                        

                                        
                                

                               
                                

                                        
                                        

                                        
                                    

                                    

                                            
                                            
                                        

                                       
                        
                        

    	

                        

                            


  

                                                
                                                
                                            


                                    

                                            
                                            

                                            
                                        


                                    

                                            
                                            

						


		 
						

                            

                        

                
        


        

            Identification
            

                    

                        

                        
                        
                        

                        

                                
                                
                         

                         

                                
                                
                         

                         

                                
                                
                         

                         

                                

                            
                            
                          
                               
                         

                        

            

        


        

            Permanent Address


            

                    

                        
                    
                        
                  

                


                  

                        

                        
                            
                      

                      

 

            

                    

                            

                            
                                
                          

                        

                          

                                

                                
                                    
                              


                              

                                    
                                        
                                  

                         

                            

                            
                            
                          

                        
                      

                              
                       
            

            

                 
        

        

                Present Address
    
    
                

                        

                            
                        
                            
                      

                    

    
                      

                            

                            
                                
                          

                          

    
        
                   
         
    
                

                        

                                

                                
                                    
                              

                              

                                    

                                    
                                        
                                  

    
                                  

                                        
                                            
                                      

    
                                  

                                  
                            

                                

                                
                                
                              

                            
                          

                            

                

                

                        
                          
         
            

            

                Contact Information
                

                        

                                

                                    
                                    
                                

                                

                                        
                                        
                                    

                                    

                                            
                                            
                                        

                                        

                                                
                                                
                                            

                                            

                                                    
                                                    
                                                



                        

                

            


            

                Other Details
                

                        

                            
                            

                                   
                                 
                            
                                 

                                        Have you taken up legal permanent resident status in any country other than that of your nationality? 
                                 

                                    
             
                                Yes
                                No
                                 
 
                                 
	
                                    If answer is "yes" , which country? 
                                    
                                 

    
                            

                            

                                   
                                   
                            
                                 

                                        Have you taken any legal steps towards changing your present nationality? 
                                 

                                  
             
                                Yes
                                No
                                 
 
                               

                                    If answer is "yes" explain fully, 
                                    
                                 

    
                            

                        

                    

            

            

                Directors
 

		
		
		Add Director
               
                
            	   
	     
                    

            


            

                    Legal Details
                    

                            

                                
                                

                                       
                                    
                                
                                     

                                            Have you ever been arrested , indicted or summoned into court as a defendant in a criminal or civil proceeding, or convited, fined or imprisoned for violation of any law (excluding minor traffic violations)?  
                                     

                                     
             
                                    Yes
                                    No
                                     
 
                                  
        
                                

                                
                        

                    

                        

                                

                        

                                If Yes, please give full particulars of each case in an attached statement.
                                

                                
                                
                             

                            

                            



                


                

                        Spouse Information  "(If Applicable)"
                


                
                        

                                

                                               
                                               
                                   

       
                                   

                                   
                                   
                                   

       
                                   

                                           
                                           
                                   


                                   

                                        
                                        
                                


                                

                        

                  
                        
                 

                 


                
                        

                                

                                        
                                        
                                

                                

                                        
                                        

                                        
                                

                               


				
				 
				

                                

                                        
                                        

                                        
                                    

					

                                    

                                            
                                            

                                            
                                    


                        
                        


                      
                

        



 

            Spouse Identification
            

                    

                        

                        
                        
                        

                        

                                
                                
                         

                         

                                
                                
                         

                         

                                
                                
                         

				

                         

                                
               
                        	


				 

                        

            

        


        

            References
            
First

            

                

                    

                        
                        
                    

                    

                            
                            
                        

                        

                                
                                

                                
                            


			 

                                
                                

                                
                            

                


            

            

                
Second

                    

                        

                            
                            
                        

                        

                                
                                
                            

                            

                                    
                                    

                                    
                                


				 

                                
                                

                                
                            

                    

    
                

        




	CV Upload:    "CV of Principal Investor(s)"
	

	
	


        

            Confirmation
	  

            

                    
	
I certify that the statements made by me in answer to the foregoing questions are true, complete and correct to the best of my knowledge and belief.


  I understand that any misrepresentation or material omission made on a Personal History form or other document requested by Invest Turks and Caicos will result in the cancellation of any offer of incentives or signed Development Agreement with the Government of the Turks and Caicos Islands.
 

I hereby provide my consent for Invest Turks & Caicos to conduct a background investigation by way of credit inquiries, personal property registrations, litigation searches, bankruptcy registrations, criminal record verification and any other legally available corporate or personal information on myself and my businesses / companies. I further consent to provide Invest Turks and Caicos or their Agents with up to date records to assist them in verifying the information contained in this report.