D4.
COMMONWEALTH OF DOMINICA
Ministry of Finance
Citizenship by Investment Unit
D4. INVESTMENT AGREEMENT
This Investment Confirmation is to be completed in English and submitted by the main applicant only.
PART I: Details of the Main Applicant
Full Name
Residential
Address
Country of
Residence
Date of Birth
Gender
Passport Number /
National ID
Date and
place of issue
M
F
Please list the details of all family members included in this application:
Full Name
Date of Birth (dd/mm/yyyy)
Total Investment Payable to Government Fund
PART II: Investment Agreement
Relationship to main applicant
USD $
I, the undersigned,_________________________________________________, hereby agree that within thirty (30) days of
receiving an Approval in Principle letter from the Citizenship by Investment Unit with regard to my Citizenship by Investment
Application, I will pay the total amount as specified above into the Government Fund held at the National Bank of Dominica in
Dominica, as specified in this document. I understand that this escrow account is an account opened and operated under the
supervision of the Ministry of Finance of the Commonwealth of Dominica. I understand that no interest is due and or payable
on funds held in escrow.
Government of Dominica
Place and Date
Economic Citizenship Account
Account No. 115003026
Signature of applicant
National Bank of Dominica
64 Hillsborough Street
Roseau, Commonwealth of Dominica
Swift No. NCDMDMDM
D4. Investment Agreement | © 2014 Government of Dominica |
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